Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population

Trenden L. Flanigan; Eric M. Kiskaddon; Jonathan Rogozinski; Matthew D. Thomas; Andrew W Froehle; Anil Krishnamurthy

doi:10.1016/j.arth.2020.11.006

Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population

Trenden L. Flanigan, Eric M. Kiskaddon, Jonathan Rogozinski, Matthew D. Thomas, Andrew W Froehle, Anil Krishnamurthy

Orthopaedic and Plastic Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3 id="x-x-sectitle0015"> Background </h3> <p id="x-x-abspara0010"> Improved <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/perioperative-period" title="Learn more about perioperative care from ScienceDirect's AI-generated Topic Pages"> perioperative care </a> for total joint <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/arthroplasty" title="Learn more about arthroplasty from ScienceDirect's AI-generated Topic Pages"> arthroplasty </a> (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/inpatient" title="Learn more about in patients from ScienceDirect's AI-generated Topic Pages"> in patients </a> that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1. <h3 id="x-x-sectitle0020"> Methods </h3> <p id="x-x-abspara0015"> A retrospective cohort of 451 patients who underwent a hip or knee TJA procedure from April 2015 to March 2018 with planned discharge on POD 1 was analyzed. <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/patient-characteristics" title="Learn more about Patient characteristics from ScienceDirect's AI-generated Topic Pages"> Patient characteristics </a> included demographics, lab values, course of <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/therapeutic-procedure" title="Learn more about treatment from ScienceDirect's AI-generated Topic Pages"> treatment </a> , procedure, <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/charlson-comorbidity-index" title="Learn more about Charlson Comorbidity Index from ScienceDirect's AI-generated Topic Pages"> Charlson Comorbidity Index </a> (CCI), complications, and other factors. Statistical regression was used to identify factors associated with delayed discharge; odds ratios (OR) were calculated for significant factors (α = 0.05). <h3 id="x-x-sectitle0025"> Results </h3> <p id="x-x-abspara0020"> Of those studied, 70/451 (15.5%) experienced a delay from the planned POD 1 discharge. An increased likelihood of delayed discharge was associated with a nonhome discharge ( <em> P </em> < .001, OR = 8.72 [95% CI: 4.22-18.06]) and higher CCI ( <em> P </em> = .034, OR = 1.16 [95% CI: 1.01-1.32]). Inpatient physical therapy on the <a href="https://www-sciencedirect-com.ezproxy.libraries.wright.edu/topics/medicine-and-dentistry/day-of-surgery" title="Learn more about day of surgery from ScienceDirect's AI-generated Topic Pages"> day of surgery </a> was found to significantly correlate with successful discharge on POD 1 ( <em> P </em> = .004, OR = 0.44 [95% CI: 0.25-0.77]). <h3 id="x-x-sectitle0030"> Conclusion </h3> <p id="x-x-abspara0025"> Most patients can be discharged on POD 1 after TJA. Physical therapy on the day of surgery increased the likelihood of patients being discharged on POD 1. Those with a higher CCI and a nonhome discharge were more likely to have a discharge delay. This information can help surgeons counsel patients and prepare for postoperative care. </p> </p> </p> </p></p>

Original language	American English
Journal	The Journal of Arthroplasty
Volume	36
DOIs	https://doi.org/10.1016/j.arth.2020.11.006
State	Published - May 1 2021

Keywords

Arthroplasty, Replacement/rehabilitation
CCI
Veterans--United States

Disciplines

Kinesiology
Medicine and Health Sciences
Surgery

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10.1016/j.arth.2020.11.006License: CC BY

Cite this

@article{397eef8b7f07491889ae8596b78b1894,

title = "Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population",

abstract = " Background Improved perioperative care for total joint arthroplasty (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay in patients that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1. Methods A retrospective cohort of 451 patients who underwent a hip or knee TJA procedure from April 2015 to March 2018 with planned discharge on POD 1 was analyzed. Patient characteristics included demographics, lab values, course of treatment , procedure, Charlson Comorbidity Index (CCI), complications, and other factors. Statistical regression was used to identify factors associated with delayed discharge; odds ratios (OR) were calculated for significant factors (α = 0.05). Results Of those studied, 70/451 (15.5%) experienced a delay from the planned POD 1 discharge. An increased likelihood of delayed discharge was associated with a nonhome discharge ( P < .001, OR = 8.72 [95% CI: 4.22-18.06]) and higher CCI ( P = .034, OR = 1.16 [95% CI: 1.01-1.32]). Inpatient physical therapy on the day of surgery was found to significantly correlate with successful discharge on POD 1 ( P = .004, OR = 0.44 [95% CI: 0.25-0.77]). Conclusion Most patients can be discharged on POD 1 after TJA. Physical therapy on the day of surgery increased the likelihood of patients being discharged on POD 1. Those with a higher CCI and a nonhome discharge were more likely to have a discharge delay. This information can help surgeons counsel patients and prepare for postoperative care. ",

keywords = "Arthroplasty, Replacement/rehabilitation, CCI, Veterans--United States",

author = "Flanigan, {Trenden L.} and Kiskaddon, {Eric M.} and Jonathan Rogozinski and Thomas, {Matthew D.} and Froehle, {Andrew W} and Anil Krishnamurthy",

year = "2021",

month = may,

day = "1",

doi = "10.1016/j.arth.2020.11.006",

language = "American English",

volume = "36",

journal = "The Journal of Arthroplasty",

}

TY - JOUR

T1 - Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population

AU - Flanigan, Trenden L.

AU - Kiskaddon, Eric M.

AU - Rogozinski, Jonathan

AU - Thomas, Matthew D.

AU - Froehle, Andrew W

AU - Krishnamurthy, Anil

PY - 2021/5/1

Y1 - 2021/5/1

N2 - Background Improved perioperative care for total joint arthroplasty (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay in patients that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1. Methods A retrospective cohort of 451 patients who underwent a hip or knee TJA procedure from April 2015 to March 2018 with planned discharge on POD 1 was analyzed. Patient characteristics included demographics, lab values, course of treatment , procedure, Charlson Comorbidity Index (CCI), complications, and other factors. Statistical regression was used to identify factors associated with delayed discharge; odds ratios (OR) were calculated for significant factors (α = 0.05). Results Of those studied, 70/451 (15.5%) experienced a delay from the planned POD 1 discharge. An increased likelihood of delayed discharge was associated with a nonhome discharge ( P < .001, OR = 8.72 [95% CI: 4.22-18.06]) and higher CCI ( P = .034, OR = 1.16 [95% CI: 1.01-1.32]). Inpatient physical therapy on the day of surgery was found to significantly correlate with successful discharge on POD 1 ( P = .004, OR = 0.44 [95% CI: 0.25-0.77]). Conclusion Most patients can be discharged on POD 1 after TJA. Physical therapy on the day of surgery increased the likelihood of patients being discharged on POD 1. Those with a higher CCI and a nonhome discharge were more likely to have a discharge delay. This information can help surgeons counsel patients and prepare for postoperative care.

AB - Background Improved perioperative care for total joint arthroplasty (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay in patients that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1. Methods A retrospective cohort of 451 patients who underwent a hip or knee TJA procedure from April 2015 to March 2018 with planned discharge on POD 1 was analyzed. Patient characteristics included demographics, lab values, course of treatment , procedure, Charlson Comorbidity Index (CCI), complications, and other factors. Statistical regression was used to identify factors associated with delayed discharge; odds ratios (OR) were calculated for significant factors (α = 0.05). Results Of those studied, 70/451 (15.5%) experienced a delay from the planned POD 1 discharge. An increased likelihood of delayed discharge was associated with a nonhome discharge ( P < .001, OR = 8.72 [95% CI: 4.22-18.06]) and higher CCI ( P = .034, OR = 1.16 [95% CI: 1.01-1.32]). Inpatient physical therapy on the day of surgery was found to significantly correlate with successful discharge on POD 1 ( P = .004, OR = 0.44 [95% CI: 0.25-0.77]). Conclusion Most patients can be discharged on POD 1 after TJA. Physical therapy on the day of surgery increased the likelihood of patients being discharged on POD 1. Those with a higher CCI and a nonhome discharge were more likely to have a discharge delay. This information can help surgeons counsel patients and prepare for postoperative care.

KW - Arthroplasty, Replacement/rehabilitation

KW - CCI

KW - Veterans--United States

UR - https://corescholar.libraries.wright.edu/kinesiology_health/82

U2 - 10.1016/j.arth.2020.11.006

DO - 10.1016/j.arth.2020.11.006

M3 - Article

C2 - 33358308

VL - 36

JO - The Journal of Arthroplasty

JF - The Journal of Arthroplasty

ER -

Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population

Abstract

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