Day of Week and Surgery Location Effects on Stay Length and Cost for Total Joint Arthroplasty: Academic versus Orthopaedic-Specific Hospital

Martino, John; Peterson, Blake E.; Thompson, Samuel F; Cook, James L.; Aggarwal, Ajay

doi:10.1055/s-0037-1615299

Cited by 13 publications

(23 citation statements)

References 18 publications

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“…Age older than 75 years, ASA 3 or 4, and increasing Charlson Comorbidity Index were associated with increased length of stay, whereas BMI did not affect length of stay; these results are consistent with existing publications. 5,6,9,15,17,18,24 Although BMI may contribute to increased medical comorbidities, it did not affect the length of stay for instrumented spine cases analyzed in this study. The 18-to 40-year-old group demonstrated the longest length of stay, but this seems to be skewed by a small number of cases that had a prolonged length of stay because the SD was higher than the other groups and the median length of stay matched the median length of stay (2.0 days, 1.0 to 3.0 interquartile range) for the entire study population.…”

Section: Discussionmentioning

confidence: 77%

“…If the surgery took place earlier in the week (Monday, Tuesday, or Wednesday), there was a notable decrease in the length of stay compared with cases that took place later in the week (Thursday or Friday). [4][5][6][7][8][9][10] This trend demonstrated in total joint arthroplasty has not been replicated in the all-spine literature. An anterior cervical diskectomy and fusion (ACDF) length of stay was not affected by the day of the week the surgery took place, 11 and similarly, for a minimally invasive lumbar decompression, there was no difference in length of stay when comparing a surgery that took place early in the week and later in the week.…”

mentioning

confidence: 99%

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Effect of Instrumented Spine Surgery on Length of Stay

Lundgren,

Detwiler,

Lamping

et al. 2023

JAAOS Glob Res Rev

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Introduction:Total joint arthroplasty studies have identified that surgeries that take place later in the week have a longer length of stay compared with those earlier in the week. This has not been demonstrated in studies focused on anterior cervical diskectomy and fusions or minimally invasive lumbar laminectomies. All-inclusive instrumented spine surgeries, however, have not been analyzed. The purpose of this study was to determine whether day of surgery affects length of stay and whether there are predictive patient characteristics that affect length of stay in instrumented spine surgery.Methods:All instrumented spine surgeries in 2019 at a single academic tertiary center were retrospectively reviewed. Patients were categorized for surgical day and discharge disposition to home or a rehabilitation facility. Differences by patient characteristics in length of stay and discharge disposition were compared using Kruskal-Wallis and chi square tests along with multiple comparisons.Results:Seven hundred six patients were included in the analysis. Excluding Saturday, there were no differences in length of stay based on the day of surgery. Age older than 75 years, female, American Society of Anesthesiology (ASA) classification of 3 or 4, and an increased Charlson Comorbidity Index were all associated with a notable increase in length of stay. While most of the patients were discharged home, discharge to a rehabilitation facility stayed, on average, 4.7 days longer (6.8 days compared with 2.1 days, on average) and were associated with an age older than 66 years old, an ASA classification of 3 or 4, and a Charlson Comorbidity Index of 1 to 3.Conclusions:Day of surgery does not affect length of stay in instrumented spine surgeries. Discharge to a rehabilitation facility, however, did increase the length of stay as did age older than 75 years, higher ASA classification, and increased Charlson Comorbidity Index classification.

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Section: Discussionmentioning

confidence: 77%

mentioning

confidence: 99%

Effect of Instrumented Spine Surgery on Length of Stay

Lundgren,

Detwiler,

Lamping

et al. 2023

JAAOS Glob Res Rev

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“…The risk of bias in each article was increased by the following factors (Table III). Every article utilized a retrospective design 8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Seven studies evaluated patient outcomes without providing or controlling for patient demographic information 11,12,[19][20][21]25,26 .…”

Section: Modified Jbi Quality Appraisalmentioning

confidence: 99%

“…Seven studies evaluated patient outcomes without providing or controlling for patient demographic information 11,12,[19][20][21]25,26 . Martino et al included limited demographic information 16 . Seven articles reported outcomes for only 1 type of procedure 14,15,18,19,23,24,27 .…”

Section: Modified Jbi Quality Appraisalmentioning

confidence: 99%

“…Seven articles reported outcomes for only 1 type of procedure 14,15,18,19,23,24,27 . Eight articles reported outcomes for only 2 procedures 8,13,16,17,20,22,26,28 . Twelve articles evaluated operations performed at the same institution as the authors, introducing risk of bias 11,[13][14][15][16][17][18][19][20][22][23][24] .…”

Section: Modified Jbi Quality Appraisalmentioning

confidence: 99%

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Orthopaedic Specialty Hospitals Compared with General Hospitals

et al. 2021

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Background:Theoretically, orthopaedic specialty hospitals (OSHs) offer multiple advantages compared with general hospitals; however, their overall benefit is debated. This review aims to compare patient characteristics and outcomes between OSHs and general hospitals in the United States.Methods:A systematic review was performed by querying PubMed and Embase from inception to April 2020 for articles comparing patient characteristics and clinical and economic outcomes between OSHs and general hospitals. Two researchers reviewed the articles according to prespecified criteria.Results:The literature review yielded 3,715 articles, of which 19 were included. All articles were retrospective in nature. There were conflicting results with regard to preferential patient selection and profitability. OSHs generate a greater surgical volume, while decreasing operative time and length of stay, compared with general hospitals. Adverse outcomes have been reported to be less common at OSHs; however, this benefit is not supported by recent matched-cohort studies. Only 1 study evaluated patient satisfaction, and this study demonstrated improved satisfaction with OSHs.Conclusions:The literature with regard to OSHs is limited by low-quality studies, often yielding inconsistent results. OSHs appear to offer some benefits; however, it is unclear if improved outcomes are due to better patient care or preferential patient selection.

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