Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty

Abstract

Aims In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip. Methods The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and hip arthroplasties (TKA, THA) between 2011 and 2017. Patients waiting longer than the recommended 180 days Canadian national standard were compared to patients waiting equal or less than the standard WT. The primary outcome measure was acute LoS postoperatively. Secondarily, patient demographics, comorbidities, and perioperative parameters were correlated with LoS with multivariate regression. Results A total of 11,833 TKAs and 6,627 THAs were included in the study. Mean WT for TKA was 348 days (1 to 3,605) with mean LoS of 3.6 days (1 to 98). Mean WT for THA was 267 days (1 to 2,015) with mean LoS of 4.0 days (1 to 143). There was a significant increase in mean LoS for TKA waiting longer than 180 days (2.5% (SE 1.1); p = 0.028). There was no significant association for THA. Age, sex, surgical year, admittance from home, rural residence, household income, hospital facility, the need for blood transfusion, and comorbidities were all found to influence LoS. Conclusion Surgical WT longer than 180 days resulted in increased acute LoS for primary TKA. Meeting a shorter WT target may be cost-saving in a social healthcare system by having shorter LoS. Cite this article: Bone Jt Open 2021;2(8):679–684.

Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent

“…[6][7][8][9][10][11] Preoperative risk-scoring for a postoperative adverse outcome is particularly useful. [12][13][14][15] One advantage is that preoperative scoring will inform the consent process. Patients should be given a likelihood of PLOS and the associated operation-related morbidity based on their preoperative risk.…”

Effects of home-based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty

“…It is important to consider that the studies included in this review were conducted before the COVID-19 pandemic with the longest waiting times recorded at up to six months from diagnosis to surgery. Wait times longer than 180 days have been linked to significantly increased hospital LOS following TKA, 70 and possibly contribute to the further clinical deterioration of arthritis and associated musculoskeletal deconditioning. 66 , 67 Currently, healthcare systems globally face significantly longer waiting times for surgery and hospital LOS compared to before the pandemic.…”

The painful truth of waiting for hip and knee arthroplasty in Northern Ireland

“…There are other costs associated with long waits, including increased length of hospital stay in patients with longer waiting times. 38 A formal evaluation of the associated costs with prolonged waiting times is certainly an important area for future research.…”