Changes to Anticipated Disposition Prevent Timely Discharge After Total Joint Arthroplasty

Area of Science:

• Orthopedic Surgery
• Healthcare Management
• Patient Outcomes

Background:

• Total joint arthroplasty (TJA) is a common procedure with significant resource utilization.
• Optimizing length of stay (LOS) is crucial for hospital efficiency and patient recovery.
• Effective preoperative planning is essential for managing patient expectations and resource allocation.

Purpose of the Study:

• To evaluate the impact of preoperative disposition planning on LOS in patients undergoing TJA.
• To identify factors contributing to prolonged LOS beyond initial predictions.
• To analyze the relationship between disposition changes and extended hospital stays.

Main Methods:

• Retrospective chart review of 679 patients undergoing primary TJA.
• Analysis of demographics, social factors, and Risk Assessment and Prediction Tool (RAPT) scores.
• Comparison of predicted versus actual LOS and disposition for patients exceeding expected stay.

Main Results:

• Average predicted LOS was 2.4 days; average actual LOS was 2.7 days.
• 336 patients exceeded their anticipated LOS.
• A change in disposition was the most significant factor (p < 0.001) for prolonged LOS, affecting 82 patients.

Conclusions:

• Changes in preoperative disposition planning, both to higher or lower levels of care, are associated with increased LOS after TJA.
• Accurate disposition planning is critical for managing patient flow and hospital resources in TJA.
• Further research into predictive models for disposition is warranted to minimize LOS variability.