What preoperative patient-related factors predict inpatient recovery of physical functioning and length of stay after total hip arthroplasty? A systematic review

Elings, J.; Hoogeboom, Thomas J.; Sluis, G. van der; Meeteren, N.L.U. van

doi:10.1177/0269215514545349

Cited by 36 publications

(31 citation statements)

References 38 publications

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“…These results contrast to those published by Elings et al (2015), which (based on 2 included studies) reported moderate-level evidence for preoperative ADL status, female sex, and BMI; and conflicting evidence for increased age, as prognostic factors of delayed inpatient recovery following THA. Moderate-level evidence indicated no association for ASA PRISMA flow diagram.…”

Section: Discussioncontrasting

confidence: 99%

“…Screening could be implemented conjointly with the decision to proceed to surgery, thus maximizing the preoperative window. Simple performance measures may identify patients potentially at risk of delayed recovery, providing the opportunity for preoperative medical and functional optimization, and prompt discharge planning (Elings et al 2015, Oosting et al 2016. Prehabilitation has been demonstrated to improve preoperative function (Swank et al 2011, Clode et al 2018) and may successfully be implemented via telerehabilitation (Doiron-Cadrin et al 2019), thereby capturing patients with reduced access (Westby et al 2010), whilst avoiding significant cost burden to both patients and healthcare organizations (Fusco and Turchetti 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of Enhanced Recovery Pathways using validated outcome measures appropriate for the early postoperative period is warranted. studies, Elings et al (2015) reported moderate and conflicting levels of evidence regarding the association between patientrelated factors and inpatient functional recovery. Therefore, this systematic review examines the evidence for patient and surgical prognostic factors for inpatient functional recovery following both total hip arthroplasty (THA) and total knee arthroplasty (TKA); determines whether inpatient functional recovery varies between these procedures; and identifies whether validated outcome measures relevant to the patient's functional requirements for hospital discharge are routinely assessed.…”

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confidence: 99%

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Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review

et al. 2020

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Background and purpose — Essential for safe and timely hospital discharge, inpatient functional recovery following lower limb arthroplasty is also variable. A previous systematic review reported moderate and conflicting levels of evidence regarding patient-related predictors of inpatient recovery for primary total hip arthroplasty (THA). A systematic review of surgical prognostic factors for inpatient recovery following THA or total knee arthroplasty (TKA) is yet to be undertaken. We identified patient and surgical prognostic factors for inpatient functional recovery following THA and TKA; determined whether inpatient functional recovery varies between these procedures; and established whether validated outcome measures relevant to the patient’s functional requirements for hospital discharge are routinely assessed. Patients and methods — Critical Appraisal Skills Programme checklists assessed methodological quality, and a best-evidence synthesis approach determined the levels of evidence supporting individual prognostic factors. PubMed, CINAHL, Embase, Scopus, and PEDro databases were searched from inception to May 2019. Included studies examined patient or surgical prognostic factors and a validated measure of post-operative function within 2 weeks of primary, unilateral THA or TKA. Results — Comorbidity status and preoperative function are supported by a strong level of evidence for TKA. For THA, no strong level of evidence was found for patient-related prognostic factors, and no surgical factors were independently prognostic for either arthroplasty site. Limited evidence supports fast-track protocols in the TKA population. Interpretation — Preoperative screening and optimization is recommended. Assessment of Enhanced Recovery Pathways using validated outcome measures appropriate for the early postoperative period is warranted.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review

et al. 2020

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“…All of these tools have been proven to be valid and reliable for measuring comorbidities in patients undergoing THA [18][19][20] . The influence of comorbidities on LOS was shown to be limited in our multivariate regression model, which differed from the conclusion drawn from most previous studies 34,35 . We speculated that all of the following reasons may explain the finding in our study.…”

Section: Discussioncontrasting

confidence: 99%

Limited Influence of Comorbidities on Length of Stay after Total Hip Arthroplasty: Experience of Enhanced Recovery after Surgery

Ding

Liang

et al. 2019

Orthopaedic Surgery

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Objectives To identify predictors of length of stay (LOS) after total hip arthroplasty (THA) in an enhanced recovery after surgery (ERAS) program and evaluate the safety and cost‐efficiency of the ERAS program with reduced LOS for unselected patients in a Chinese population. Methods A total of 311 consecutive, unselected patients undergoing primary THA at a single institution were retrospectively reviewed and divided into two groups: LOS ≤ 3 and LOS > 3 group. All patients were managed with the same ERAS protocol and went back home after discharge. Multivariate logistic regression analysis was used to determine independent risk factors for LOS > 3. Harris Hip Score at 90‐day follow‐up, 90‐day readmission rate, and hospitalization costs were compared between two groups. Results Multivariate regression analysis identified female gender (odds ratio [OR] = 2.623), living alone (OR = 4.127), and primary osteoarthritis of hip (OR = 3.565) to be correlated with LOS > 3. Preoperative hemoglobin (HB), postoperative HB, drain use, blood transfusion, diabetes, respiratory disease, osteoporosis, number of comorbidities, and CCI score showed no significant influence on LOS after adjusting for other risk factors in the multivariate model. Harris Hip Score and readmission rate at 90‐day follow‐up showed no significant differences between two groups. Patients in LOS > 3 group had approximately 3948.6 Chinese yuan higher hospital costs. Conclusion Female gender, living alone, and primary osteoarthritis of hip were identified as independent risk factors for prolonged LOS. The experience from our institution suggested aggressive management of comorbidities in the ERAS program can minimize the influence of comorbidities on LOS. The safety, efficiency, and costs‐saving benefits of the ERAS program with reduced LOS for unselected patients was confirmed in this study.

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“…Although to our knowledge this is the first systematic literature review and meta-analysis where the primary outcome of interest is discharge destination, systematic reviews on patient factors predictive of increased length of hospital stay following TJA have been published [Elings, Shah]. The findings of this review are consistent with those reported patient risk factors associated with longer length of stay, including female gender, older age, increased comorbidities and higher BMI [31,32].…”

Section: Patient Reported Outcome Measuressupporting

confidence: 76%

Intrinsic Patient Factors Predictive of Inpatient Rehabilitation Facility Discharge Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Sattler

Hing

Rathbone

et al. 2020

Preprint

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Background Total Knee Arthroplasty (TKA) reduces pain and improves function in those suffering from severe osteoarthritis. A significant cost of TKA is post-acute care, however, current evidence suggests that discharge to an Inpatient Rehabilitation Facility (IRF) has inferior outcomes to home discharge, with no greater benefit in physical function. Only individual studies have investigated TKA patient characteristics predictive of discharge destination, therefore, the aim is to systematically review the literature and meta-analyse intrinsic patient factors predictive of IRF discharge. If predictive factors are known, then early discharge planning and intervention strategies could be implemented. Methods Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to October 2019 for articles investigating pre-operative intrinsic patient factors predictive of IRF discharge. For assessing the methodological quality of included studies, the Quality In Prognosis Studies (QUIPS) tool was used. Statistical analysis and graphical reporting were conducted in R statistical software. To assess the effect of predictors of discharge destination, odds ratios with the corresponding 95%CI were extracted from the results of univariate and multivariable analyses. Results A total of 9 articles published between 2011 to 2018 with 218,151 TKA patients were included. Of the 13 intrinsic patient factors reported, 6 met the criteria for synthesised review: age, obesity, comorbidity, gender, SF-12/VR-12 survey, and smoking. Due to the heterogeneity of statistical analysis and reporting 2 variables could undergo meta-analysis, gender and smoking. Female gender increased the likelihood of IRF discharge by 1.78 (OR=1.78; 95%CI=1.43–2.20; I2=33.3%), however, the relationship between smoking status and discharge destination was less certain (OR=0.80; 95%CI=0.42–1.50; I2=68.5%). Conclusion Female gender was shown to be predictive of IRF discharge after total knee arthroplasty. There was also a trend for those of older age, increased comorbidity or the severely obese to have an increased likelihood of IRF discharge. This systematic review and meta-analysis suggests that the heterogeneity of existing literature is inadequate to develop a predictive model for intrinsic patient factors associated with IRF discharge. Further, high quality studies of prospective design on predictive factors are warranted, to enable early discharge planning and optimise resource consumption on post-acute care following TKA.

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What preoperative patient-related factors predict inpatient recovery of physical functioning and length of stay after total hip arthroplasty? A systematic review

Cited by 36 publications

References 38 publications

Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review

Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review

Limited Influence of Comorbidities on Length of Stay after Total Hip Arthroplasty: Experience of Enhanced Recovery after Surgery

Intrinsic Patient Factors Predictive of Inpatient Rehabilitation Facility Discharge Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

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