Published online Dec 18, 2018. doi: 10.5312/wjo.v9.i12.285
Peer-review started: October 4, 2018
First decision: October 29, 2018
Revised: November 6, 2018
Accepted: December 10, 2018
Article in press: December 10, 2018
Published online: December 18, 2018
To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).
The study included primary TKA’s performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.
Eight hundred and six consecutive primary SSP TKA’s were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer (P < 0.001)], female gender [4.3 h longer (P = 0.012)], age [3.5 h longer per ten-year increase in age (P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported (P = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time (P = 0.004)] and Black or African American patients [6.1 h longer (P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter (P = 0.011)] and TKA’s performed during holiday weeks [9.4 h shorter (P = 0.011)]. Non-significant factors included: BMI, median income, patient’s living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.
The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.
Core tip: In an effort to decrease post-operative length of stay (LOS), many institutions continue to develop optimal discharge pathways. Since LOS is dependent upon many variables, we sought to define which socio-demographic factors influence LOS in total knee arthroplasty (TKA). Six factors were found to increase LOS: Age, gender, Black or African American race, simultaneous bilateral TKA, later procedure end times and number of PRA. Two factors decreased LOS, patient being married and surgery during a major public holiday week. While none of the patient specific factors are modifiable by the clinician, we do have the ability to optimize surgical schedule and allocation of resources.