Predictors of extended length of stay after unicompartmental knee arthroplasty

Sephton, B.M.; Bakhshayesh, Peyman; Edwards, Tim; Ali, Adam M.; Singh, Vivek; Nathwani, Dinesh

doi:10.1016/j.jcot.2019.09.009

Cited by 18 publications

(19 citation statements)

References 41 publications

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“…Preoperative patient characteristics such as old age, high ASA class, high body mass index, and female sex have repeatedly been shown to predict less likelihood of discharge on DOS after JRS, including PKR [ 33 – 36 ]. Recent studies have highlighted old age [ 4 , 36 , 37 ] and cardiovascular disease [ 4 , 37 ] as predictors of undesirable outcomes such as extended LOS, complication, and readmission. The same associating factors (age, ASA class, gender, and cardiovascular disease in particular) were repeated in this study of those not being discharged on DOS.…”

Section: Discussionmentioning

confidence: 99%

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Tveit

2021

PLoS ONE

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Purpose Programs referred to as Fast-Track/Rapid Recovery/Enhanced Recovery After Surgery have proven both effective and safe in joint replacement surgery, to the degree where same-day discharge (SDD) has been attempted in carefully selected cases at specialized outpatient units. Therefore, the primary aim of this study was to evaluate a same-day surgery protocol regarding safety using the minor partial knee replacement (PKR) procedure by non-selectively recruiting patients at a public hospital for one consecutive year. Methods 33 unselected PKR cases were included in this open clinical trial. The inclusion/exclusion criteria were solely based on logistics, as all the procedures were medial PKRs, designated the first morning slots, and performed by one single-surgeon. Strict postoperative criteria based on vital parameters, urinary function, bleeding, and mobilization had to be met before discharge was considered. SDD rate, patient satisfaction, number of outpatient visits, adverse events and readmissions within 90 days were evaluated. A predetermined subgroup analysis was also conducted where patients <80 yrs. and with an American Society of Anesthesiologists (ASA) classification <III was compared with those aged ≥80 yrs. and/or ASA class ≥III. Results 29 of 33 (88%) successfully achieved SDD. In a univariate comparison, 100% of the patients <80 yrs. and ASA class <III achieved SDD, whereas a corresponding 43% applied for those aged ≥80 yrs. and/or ASA class ≥III (p = 0.001). A 93% overall satisfaction rate was reached. Only 8% extra outpatient visits were required, all occurring within the first 2 weeks (well in line with routine practice.) One plausible transient ischemic attack and one readmission caused by a penetrating trauma not affecting the knee were identified, both of which happened 10 weeks after surgery. No adverse events or readmissions occurred within the first 48 hours of surgery. Conclusion When following strict criteria for discharge, same-day partial knee replacement surgery may be both feasible and safe, even without preselection of patients.

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Section: Discussionmentioning

confidence: 99%

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Tveit

2021

PLoS ONE

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“…Therefore, other patient characteristics and preoperative comorbidity beyond high BMI and age might influence the risk of prolonged admission. In contrast, other studies have A study from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) reported that most UKA patients were obese and 9.2% were morbidly reported higher BMI to be associated with prolonged admission (Haughom et al 2015, Sephton et al 2020. Differences in variables included in the adjusted analyses as well as the adherence to fast-track principles could potentially contribute to the above-mentioned discrepancies.…”

Section: Readmission Within 90 Days Of Surgerymentioning

confidence: 93%

“…The few studies investigating the effect of BMI and age on LOS and readmission after UKA have varying conclusions. Some studies have associated higher BMI with increased risk of prolonged admission as well as short-term complications, while others find no such association (Otero et al 2016, Plate et al 2017, Sephton et al 2020. Likewise, day of surgery (DOS) discharge is reported to be less likely in older patients while some do not find this association (Haughom et al 2015, Matsumoto et al 2020.…”

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confidence: 99%

Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty

et al. 2021

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Background and purpose — The indications for unicompartmental knee arthroplasty (UKA) have become less restrictive and, today, high age and high BMI are not considered contraindications by many surgeons. While the influence of these patient characteristics on total knee arthroplasty is well documented, evidence on UKA is lacking. We investigated the effect of BMI and age on day of surgery (DOS) discharge, prolonged admission, and 90-day readmission following UKA surgery. Patients and methods — This retrospective cohort study included 3,897 UKA patients operated on between 2010 and 2018 in 8 fast-track arthroplasty centers. Patients were divided into 5 BMI groups and 5 age groups. Differences between groups in the occurrence of DOS discharge, prolonged admission > 2 days, and 90-day readmission was investigated using a chi-square test and mixed-effect models adjusted for patient characteristics using surgical center as a random effect. Results — Median LOS was 1 day. DOS discharge was achieved in 26% of patients with no statistically significant differences between BMI groups. DOS discharge was less likely in UKA patients aged > 70 years (age 71–80; odds ratio [OR] 0.7 [95% CI 0.6–0.9]). Prolonged admission was not affected by BMI or age in the adjusted analysis. 90-day readmission was more likely in patients with BMI > 35 (OR 1.9 [CI 1.1–3.1]) and patients aged 71–80 (OR 1.5 [CI 1.1–2.1]). Interpretation — Age > 70 years decreased the likelihood of DOS discharge after UKA. High BMI as well as advanced age increased the likelihood of 90-day readmission. This should be noted by surgeons operating on patients with high BMI and age.

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“…41 Recently, Sephton et al retrospectively evaluated prolonged LOS following UKA at their institution. 46 While significantly fewer patients ! 75 years of age were seen in the "fast track" group (LOS 3 days) compared with the "long stayers" group (LOS > 3 days), 14 and 30%, respectively, only ASA classes 3 to 4 and history of cardiovascular disease were found to be independent predictors of extended LOS following UKA in multivariable regression analysis.…”

Section: Hospital Length Of Staymentioning

confidence: 99%

“…75 years of age were seen in the "fast track" group (LOS 3 days) compared with the "long stayers" group (LOS > 3 days), 14 and 30%, respectively, only ASA classes 3 to 4 and history of cardiovascular disease were found to be independent predictors of extended LOS following UKA in multivariable regression analysis. 46 Finally, Jensen et al prospectively evaluated factors associated with continued postoperative hospitalization following "fast-tracked" UKA in 100 consecutive patients. 47 Pain and lack of mobilization were found to be the primary reasons recorded for not fulfilling discharge criteria.…”

Section: Hospital Length Of Staymentioning

confidence: 99%

Unicompartmental Knee Arthroplasty in Octogenarians versus Younger Patients: A Comparison of 30-Day Outcomes

et al. 2020

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As the United States' octogenarian population (persons 80–89 years of age) continues to grow, understanding the risk profile of surgical procedures in elderly patients becomes increasingly important. The purpose of this study was to compare 30-day outcomes following unicompartmental knee arthroplasty (UKA) in octogenarians with those in younger patients. The American College of Surgeons National Surgical Quality Improvement Program database was queried. All patients, aged 60 to 89 years, who underwent UKA from 2005 to 2016 were included. Patients were stratified by age: 60 to 69 (Group 1), 70 to 79 (Group 2), and 80 to 89 years (Group 3). Multivariate regression models were estimated for the outcomes of hospital length of stay (LOS), nonhome discharge, morbidity, reoperation, and readmission within 30 days following UKA. A total of 5,352 patients met inclusion criteria. Group 1 status was associated with a 0.41-day shorter average adjusted LOS (99.5% confidence interval [CI]: 0.67–0.16 days shorter, p < 0.001) relative to Group 3. Group 2 status was not associated with a significantly shorter LOS compared with Group 3. Both Group 1 (odds ratio [OR] = 0.15, 99.5% CI: 0.10–0.23) and Group 2 (OR = 0.33, 99.5% CI: 0.22–0.49) demonstrated significantly lower adjusted odds of nonhome discharge following UKA compared with Group 3. There was no significant difference in adjusted odds of 30-day morbidity, readmission, or reoperation when comparing Group 3 patients with Group 1 or Group 2. While differences in LOS and nonhome discharge were seen, octogenarian status was not associated with increased adjusted odds of 30-day morbidity, readmission, or reoperation. Factors other than age may better predict postoperative complications following UKA.

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Predictors of extended length of stay after unicompartmental knee arthroplasty

Cited by 18 publications

References 41 publications

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty

Unicompartmental Knee Arthroplasty in Octogenarians versus Younger Patients: A Comparison of 30-Day Outcomes

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