Understanding factors that impact the length of stay after total hip arthroplasty - A national in-patient
Nikit Venishetty1, Jack Beale2, Jack Martinez2
1Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Insights
Pre-operative comorbidities and post-operative complications significantly increase the length of stay (LOS) after total hip arthroplasty (THA). Identifying these factors can help optimize patient care and reduce healthcare costs associated with longer hospital stays.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Patient Outcomes
Background:
- Total hip arthroplasty (THA) is a common procedure with increasing utilization.
- Limited data exists on factors influencing length of stay (LOS) post-THA.
- Extended LOS increases healthcare costs, necessitating identification of contributing factors.
Purpose of the Study:
- To analyze preoperative comorbidities and postoperative complications impacting LOS after THA.
- To identify specific factors associated with prolonged hospital stays following THA.
- To inform clinical decision-making and resource allocation for THA patients.
Main Methods:
- Retrospective analysis of the Nationwide Inpatient Sample (NIS) database from 2016-2019.
- Cohort divided into patients with LOS >2 days and LOS <2 days.
- Multivariate analysis to identify independent predictors of prolonged LOS.
Main Results:
- 367,890 THA patients analyzed; 30.52% had LOS >2 days.
- Preoperative factors like diabetes, lupus, HIV, CKD, and Parkinson's disease increased LOS risk.
- Postoperative complications including renal failure, MI, PE, DVT, and infections significantly raised LOS.
Conclusions:
- Multiple preoperative comorbidities and postoperative complications are linked to increased LOS after THA.
- Patients with longer LOS incurred higher healthcare costs.
- Findings aid providers in optimizing care and resource use for THA patients to potentially reduce LOS.
Background:
Total hip arthroplasty (THA) is increasingly used every year; however, there is currently limited information on factors that impact the length of stay (LOS) following the procedure. Longer LOS following THA is met with an increase in the cost of care, necessitating studies to identify factors that may impact LOS.
Methods:
In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 to analyze the preoperative comorbidities and postoperative complications that impact the LOS following THA. We divided our cohort into patients with a LOS greater than two days, and patients with a LOS less than two days.
Results:
A total of 367,890 patients were identified in the NIS database who underwent THA during the study period. Of this cohort, 112,288 (30.52%) patients were identified as having a LOS greater than two days, while the remaining 255,602 (69.48%) patients were patients who had a LOS less than two days. Multivariate analysis demonstrated several pre-operative factors, such as diabetes, systemic lupus erythematosus, organ transplant, dialysis, the human immunodeficiency virus, chronic kidney disease, and Parkinson's disease, were independently associated with a higher risk of a LOS greater than two days. The subsequent multivariate analysis for post-operative variables demonstrated that acute renal failure, myocardial infarction, blood loss anemia, blood transfusion, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, periprosthetic mechanical complications, periprosthetic infections, and wound dehiscence were all independently associated with a higher risk of a LOS greater than two days.
Conclusions:
Several pre-operative comorbidities and postoperative complications were found to increase the likelihood of a LOS greater than two days. In addition, the group with a LOS greater than two days incurred a higher cost of care. This information is useful for providers to make informed decisions regarding patient care and resource utilization for patients undergoing THA, potentially reducing LOS.
