Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study

Abstract

BackgroundThe annual incidence of revision hip replacements has increased in both Canada and United States, particularly in younger adults. Patients following revision hip replacements often require longer hospital length of stay (LOS) but little is known about predictors of inpatient rehabilitation LOS in this group of patients. The purpose of this study was to evaluate the socio-demographic, pre-surgery, surgery and post-surgery related factors that might influence rehabilitation LOS of inpatients following revision hip replacements.MethodsThis study included inpatients discharged from a musculoskeletal ward between 2002 and 2006 following rehabilitation revision hip replacement. Data sources included the National Reporting System, a standardized, provincial administrative database and augmented by chart abstraction. The collected elements included the outcome LOS and the following independent variables: age, sex, support at home, environmental barriers, language barrier, number of revision surgeries on the affected hip, comorbidity, previous orthopaedic surgeries in the lower extremities (L/ES), the hip component(s) revised, weight-bearing status, hemoglobin level, complications, days lapsed from surgery to rehabilitation admission and admission scores on the Functional Independence Measure (FIM). Simple linear regression was used to take forward any predictors significant at p < .10 level. Variables that satisfied the significance level were grouped in blocks and entered for regression analyses.ResultsThe 275 patients in this sample had a mean age of 69 years; 62% were female and the mean LOS was 29.6 days. Statistically significant predictors of longer LOS were low admission FIM score, female sex, revision of only the femoral component, 2 or more prior surgeries in the L/Es and 2 or more hip revisions (redo revision). The final model explained 28% of variance in inpatient LOS.ConclusionsA score of 9-14 points lower in admission FIM, female sex, revision of only the femoral component, prior surgeries in the L/Es and redo hip revision are all independent factors associated with 4-6 days longer LOS. These results may facilitate an understanding of bed flow. Additionally, patients with one or a combination of the above characteristics may benefit from enhanced care plans that facilitate achievement of rehabilitation goals for discharge home.

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

“…Lastly, our results demonstrated that early application of the motor FIM helps predict LOS, such that greater scores result in shorter LOS. This is in keeping with prior studies that show that the motor FIM is a predictive tool for THA rehabilitation LOS, and more broadly with other motor performance tasks such as the timed up‐and‐go, ability to manage stairs, and overall walking distance . As patients and therapists identify specific motor goals on rehabilitation admission, those who are closer to achieving them usually require a shorter inpatient stay.…”

“…When applying the minimum pain relief thresholds described by Salaffi et al in their study of chronic musculoskeletal pain patients, to our population, the obvious challenge in its interpretation is that chronic pain patients do not represent rehabilitation patients. For one, they tend to demonstrate central sensitization and pain catastrophizing behavior, and as such, smaller changes in pain are less likely to be reported as meaningful . As well, Tubach et al have previously shown that acute, severe pain symptoms require greater changes in pain to report clinically meaningful changes.…”

Rehabilitation of revision total hip replacement: A multi‐centre survey of current practice

“…Patients include those with significant osteolysis and loosening with increased risks for periprosthetic fracture as well as those at high risk of dislocation. However, low pre-operative function is a significant risk factor for increased LOS and predictive of worse longer-term function (Biring et al, 2007;Davis et al, 2006;Yeung et al, 2010). There are no studies of rehabilitation before RTHR but there is some evidence that exercise can improve pain, muscle strength and function before primary THR (Gill & McBurney, 2013;Skoffer, Dalgas, & Mechlenburg, 2015;Wang et al, 2016) although the size and clinical importance of these changes is debated.…”

“…Outcomes after surgery are influenced by multiple factors related to the individual, mode of THR failure, procedure and surrounding care. Evidence is accumulating about important individual and surgical factors that relate to outcomes such as sex, age, level of pre-operative function, urgent versus planned procedure, hospital procedure volume (Biring, Masri, Greidanus, Duncan, & Garbuz, 2007;Briggs, 2015;Davis et al, 2006;Lübbeke et al, 2007;Singh & Lewallen, 2009;Yeung, Davis, & Soric, 2010) but the association between rehabilitation and outcomes is poorly understood (Davis et al, 2006;Yeung et al, 2010). Revision patients may receive more rehabilitation than primary THR patients but what this comprises and its effectiveness is uncertain (Bozic et al, 2015;Yeung et al, 2010).…”

Comparative Inpatient Rehabilitation Outcomes of Total Hip Arthroplasty Patients with and without Restrictive Hip Precautions

“…The incidence of total hip arthroplasties (THA) has increased over the past 2 decades [1] and is now considered to be one of the most successful surgical procedures today. Common THA procedures employ surgical approaches either anterior or posterior to the trochanter.…”