Risk Factors for Greater Than 24-Hour Length of Stay After Primary Total Knee Arthroplasty

Johnson, Daniel J.; Castle, Joshua; Hartwell, Matthew J.; dʼHeurle, Albert; Manning, David W.

doi:10.1016/j.arth.2019.10.037

Cited by 34 publications

(33 citation statements)

References 18 publications

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“…Consequently, we used prospective data collected from the well-established Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement database to study the association between preoperative risk factors, weekday of surgery and LOS > 2 days. The results of our analysis, which found anemia, use of walking aids, age > 75 years, TKA, female sex, living alone, psychiatric, pharmacologically treated cardiac and pulmonary disease, and type of diabetes to be important risk factors, are unsurprising as they have previously been demonstrated to influence LOS > 4 days in a fast-track setup (Jørgensen and Kehlet 2013b, Jans et al 2014, Jørgensen et al 2016, Cram et al 2018, Johnson et al 2020. One of the reasons that TKA was a risk factor for LOS > 2 days may be related to more extensive pain problems compared with THA, consequently prolonging time to achieving functional discharge criteria.…”

Section: Discussionmentioning

confidence: 76%

“…(Petersen et al 2019). In contrast, there are several studies where outpatient procedures are defined as less than 24 hours or less than 2 midnights (Vehmeijer et al 2018, Johnson et al 2020 or with use of nursing care facilities or rehabilitation homes (Cram et al 2018, Ross et al 2020, which may give a false impression of reduced LOS. In this context, a limitation of our study is the lack of detailed information on discharge destination although non-home discharge after fast-track THA and TKA is limited in Denmark and even in patients > 85 years been demonstrated to occur in only about 7% of patients (Pitter et al 2016).…”

Section: Discussionmentioning

confidence: 99%

“…However, challenges still exist to further improve outcome and where the strategy must be divided between optimizing preoperative comorbidities, perioperative care, and organizational issues, of which the latter has received less attention. Preoperative risk factors have been well assessed over several years in relation to short LOS and generally confirming increased age, obesity, diabetes, cardio-pulmonary diseases, and dependent functional status as risk factors for prolonged LOS (Jørgensen et al 2016, Cram et al 2018, Kim et al 2018, Cizmic et al 2019, Gkagkalis et al 2019, Ziemba-Davis et al 2019, Johnson et al 2020. However, limited information is available from a fast-track setting on the role of weekday of surgery on LOS when adjusting for the above-mentioned risk factors.…”

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confidence: 99%

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Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

et al. 2020

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Background and purpose — Enhanced recovery programs have reduced length of stay (LOS) after hip and knee arthroplasty (THA/TKA). Although risk factors disposing to prolonged LOS are well documented, there is limited information on the role of weekday of surgery. This study analyzed the role of weekday of surgery and other potential risk factors for LOS > 2 days. Patients and methods — We included 10,576 unselected consecutive procedures between January 2016 and August 2017 within a multicenter fast-track THA/TKA collaboration with prospective collection of preoperative characteristics. We used multiple regression analysis of potential risk factors for LOS > 2 days followed by construction of a simple risk score from 0 to 15 points based on the calculated odds ratios. Results — Mean LOS was 1.9 (SD 1.8) days, with 80% of patients having surgery from Monday to Wednesday. Of these, 17% (95% CI 16–18) had a LOS > 2 days vs. 19% (CI 17–21) in those operated on Thursday and Friday. Patients were scheduled evenly throughout the week regardless of risk of LOS > 2 days and despite the fact that 38% (CI 35–40) of patients with ≥ 6 points (16% of the total population) had a LOS > 2 days compared with 14% (CI 13–14) in those with < 6 points. In these “high-risk” patients, the fraction with LOS > 2 days increased when having surgery on Thursdays or Fridays (43% CI 38–49) compared with Monday to Wednesday (37% CI 34–39). Interpretation — A detailed preoperative risk assessment may be helpful to plan the weekday of surgery in order to decrease LOS and weekend hospitalization.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

et al. 2020

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“…A retrospective review of patients undergoing primary TKA between 2011 and 2016 using National Surgical Quality Improvement Program (NSQIP) found that dependent functional status, preoperative comorbidities, and postoperative complications were associated with a LOS greater than 24 hours after TKA, while male gender, spinal anesthesia, and monitored anesthesia care were protective against LOS greater than 24 hours [34]. In a prospective cohort study of 4509 patients who underwent TKA across 4 facilities in a single health-care system, Piuzzi et al [17] analyzed patient-related risk factors and compared them with the procedure or structural factors to assess predictors of LOS after TKA.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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Background: In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA. Methods: A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 oneday length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC. Results: Controlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] ¼ 0.935, P < .001), body mass index !35 (OR ¼ 0.491, P ¼ .002), female (OR ¼ 0.535, P < .001), nonwhite race (OR ¼ 0.456, P ¼ .003), primary hypertension (OR ¼ 0.710, P ¼ .032), !3 comorbidities (OR ¼ 0.507, P ¼ .002), American Society of Anesthesiologists score !3 (OR ¼ 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (c 2 ¼ 12.437, P ¼ .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination. Conclusion: For patients undergoing primary TKA, increased age, body mass index !35, female gender, nonwhite race, primary hypertension, !3 comorbidities, and American Society of Anesthesiologists score !3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

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“…Предложены малоинвазивные либо меньшие по протяженности доступы, оптимальные варианты кровосбережения во время операции (использование турникета при рекомендуемых цифрах давления в нем 230-270 мм рт.ст. и применение транексамовой кислоты), эффективные методы обезболивания, начиная от интраоперационной локальной инфильтрационной аналгезии и заканчивая пролонгированной блокадой нервов [21]. На сегодняшний день благодаря новым подходам в хирургическом лечении пациентов с дегенеративно-дистрофическими заболеваниями крупных суставов почти в 2 раза сократилось время операции [22], которая выполняется практически бескровно (средняя интраоперационая…”

Section: материал и методыunclassified

Outpatient Pharmacological Prevention of Venous Thromboembolism after Knee Joint Replacement

Касимова¹,

Божкова²,

Сараев³

et al. 2020

Flebol.

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РЕЗЮМЕ Цель исследования. Анализ эффективности и безопасности применения ацетилсалициловой кислоты (АСК), дабигатрана, ривароксабана для профилактики венозных тромбоэмболических осложнений (ВТЭО), а также приверженности рекомендованному препарату на амбулаторном этапе пациентов после эндопротезирования коленного сустава (КС). Материал и методы. Исследование носит рандомизированный сравнительный характер. Все пациенты получали подкожную инъекцию дальтепарина натрия 2500 ЕД за 12 ч до оперативного вмешательства. Далее больных рандомизировали на 3 группы: пациенты группы А получали АСК 100 мг 1 раз в день (р/д), группы Д-дабигатрана этексилат 220 мг 1 р/д, группы Р-ривароксабан 10 мг 1 р/д в течение 35 сут после операции. Результаты профилактики на амбулаторном этапе оценивали с помощью телефонного анкетирования у 260 пациентов. Результаты. На амбулаторном этапе рекомендованное лекарственное средство принимали только 76,8%, 77% и 71% пациентов в группах А, Д и Р соответственно. Закончили полный курс тромбопрофилактики или продлили его 91,5%, 98,7% и 93,1% пациентов соответственно. Различий между группами по частоте развития нежелательных явлений, отказа от приема препарата или сокращения курса тромбопрофилактики не выявлено. Заключение. У пациентов без дополнительных факторов риска ВТЭО, перенесших эндопротезирование КС, АСК, дабигатран и ривароксабан обладают сходной эффективностью и безопасностью при профилактике ВТЭО.

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Risk Factors for Greater Than 24-Hour Length of Stay After Primary Total Knee Arthroplasty

Cited by 34 publications

References 18 publications

Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

Outpatient Pharmacological Prevention of Venous Thromboembolism after Knee Joint Replacement

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