Patient vs Provider Characteristics Impacting Hospital Lengths of Stay After Total Knee or Hip Arthroplasty

Abstract

Introduction-This study aims to identify whether patient-level or provider-level characteristics are most influential on a patient's length of stay in the acute care hospital.

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

“…Patient expectation of discharge to ECF remained a significant predictor of increased LOS even after controlling for Medicare's 3-day rule to quality for discharge to ECF. We have also confirmed earlier findings, particularly the association between LOS and age [9][10][11][12] and absence of association between LOS and BMI, sex, and comorbidities [10,13,16]. Pain and patient expectations represent compelling targets for intervention to reduce LOS.…”

“…Previous studies have identified several factors that influence LOS after primary THA, including age [9][10][11][12], sex [9,10,12], comorbidities [12,13], body mass index [14], surgical approach [15], use of assistive devices [16], functional status [12], general health perception [10,13], and surgeon experience [10]. However, many of those studies had significantly long mean LOS [9,10], excluded patients with diagnoses other than primary osteoarthritis [16], focused only on select comorbidities [12], or required the use of time-consuming scoring systems [10,13].…”

“…However, many of those studies had significantly long mean LOS [9,10], excluded patients with diagnoses other than primary osteoarthritis [16], focused only on select comorbidities [12], or required the use of time-consuming scoring systems [10,13]. Furthermore, previous studies often had postoperative rehabilitation protocols geared toward discharge to home [16], which has limited application to current practice where patients with slow postoperative recovery can be discharged to ECF.…”

Preoperative Predictors of Extended Hospital Length of Stay Following Total Knee Arthroplasty

“…This was a cross-sectional analysis of a national database that found surgeon volume and medical comorbidities to be significantly associated with LOS [15]. Medical comorbidities were measured by the Charlson comorbidity index.…”

“…Among those limitations are significantly long LOS [11], lack of physical therapy on weekends [11,12], postoperative rehabilitation criteria geared toward home-only discharge [12,13], focus on select medical comorbidities [14], inclusion of procedures other than TKA in the analysis [14], and broad exclusion criteria [15]. Furthermore, factors such as preoperative pain level and patient expectation were often not investigated.…”