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Key determinants of overnight hospital stay after total hip arthroplasty
E Muñoz-Mahamud1, A Combalia1, A Alías2
1Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Universidad de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Objectives:
Total hip arthroplasty (THA) is a highly effective procedure, with demand projected to increase significantly due to population ageing. Fast-track protocols aim to optimize perioperative management, enhance recovery, and reduce length of stay (LOS). However, LOS variability remains a concern. This study aimed to evaluate the influence of perioperative factors on LOS in patients undergoing primary THA at our institution.
Methods:
This retrospective cohort study at a single tertiary-care center included a stratified random sample of 300 primary THAs performed between January 2018 and December 2022 (100 per surgical approach: direct lateral [DL], posterolateral [PL], direct anterior [DAA]). Collected variables were age, sex, BMI, ASA class, laterality, surgical approach, use of tranexamic acid, preoperative laboratory values (hemoglobin, hematocrit, albumin, glucose), chronic anticoagulation, and surgical timing. The primary outcome was length of stay (LOS); prolonged LOS was defined as > 1 postoperative night. Continuous variables were compared using Student's t-test or the Mann-Whitney U test, and categorical variables using the Chi-square test. Statistical significance was set at P ≤ .05. The statistical analysis was primarily descriptive and exploratory, focusing on identifying associations between perioperative variables and prolonged length of stay.
Results:
Among the 300 patients, 142 (47.3%) were discharged after an overnight stay, whereas 158 (52.7%) experienced prolonged LOS. Female sex (P = .003), lower preoperative hemoglobin and hematocrit levels (P < .001), and chronic anticoagulant therapy (P = .01) were significantly associated with prolonged LOS. Conversely, the DAA was associated with shorter LOS (P < .001).
Conclusion:
Prolonged LOS was associated with female sex, anemia, and chronic anticoagulant therapy. Likewise, the DAA was associated with a shorter LOS, although these findings should be interpreted with caution due to the retrospective and exploratory nature of the study.