Top

International Orthopaedics

Published in:

01-10-2018 | Original Paper

Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful?

Authors: Stéphane Poitras, Kendrick Au, Kristi Wood, Geoffrey Dervin, Paul E. Beaulé

Published in: International Orthopaedics | Issue 10/2018

Abstract

Purpose

Variations in hospital length of stay (LOS) and function are present after hip or knee arthroplasty. Comorbidity and performance measures have been associated with post-operative outcomes. It is however not known if both independently contribute to outcome prediction. The objective of this study was to evaluate the combined predictive ability of comorbidity scores (American Society of Anesthesiologists classification system (ASA), Charlson comorbidity index (CCI), 2008 version of the CCI (CCI08)) and a performance measure (Timed-Up-and-Go (TUG)) on LOS and short-term function in patients undergoing knee or hip arthroplasty.

Methods

One hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively with the ASA, CCI, CCI08, and TUG. LOS was determined through administrative data. The Older Americans Resources and Services ADL questionnaire (OARS) was used to assess function two and six weeks after surgery. Logistic regression was used to assess the relationship between pre-operative assessments and LOS and OARS scores.

Results

Both the ASA and TUG significantly contributed to LOS prediction. Odds ratio (OR) was 3.57 (95% confidence interval (CI) 1.26–10.07) for the ASA, and 2.18 (95% CI 1.67–4.15) for a one-standard deviation (SD) increase of 4.45 s of the TUG. Only the TUG was predictive of two weeks function and trending towards significance for six weeks function. One SD TUG increase yielded an OR of 2.14 (95% CI 1.53–3.79) for two week function.

Conclusions

The TUG and ASA can be used pre-operatively in combination to predict LOS, and TUG can also be used to predict short-term post-operative function.

Available only for authorised users

Bitar YFE, Illingworth KD, Scaife SL et al (2015) Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database. J Arthroplast 30:1710–1715CrossRef

Pugely AJ, Martin CT, Gao Y et al (2014) Comorbidities in patients undergoing total knee arthroplasty: do they influence hospital costs and length of stay? Clin Orthop Relat Res 472:3943–3950. https://doi.org/10.1007/s11999-014-3918-x CrossRefPubMedPubMedCentral

Olthof M, Stevens M, Bulstra SK, van den Akker-Scheek I (2014) The association between comorbidity and length of hospital stay and costs in total hip arthroplasty patients: a systematic review. J Arthroplast 29:1009–1014. https://doi.org/10.1016/j.arth.2013.10.008 CrossRef

Elings J, Hoogeboom TJ, van der Sluis G, van Meeteren NL (2015) What preoperative patient-related factors predict inpatient recovery of physical functioning and length of stay after total hip arthroplasty? A systematic review. Clin Rehabil 29:477–492. https://doi.org/10.1177/0269215514545349 CrossRefPubMed

Charlson ME, Charlson RE, Peterson JC et al (2008) The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 61:1234–1240. https://doi.org/10.1016/j.jclinepi.2008.01.006 CrossRef

Nankaku M, Tsuboyama T, Akiyama H et al (2013) Preoperative prediction of ambulatory status at 6 months after total hip arthroplasty. Phys Ther 93:88–93. https://doi.org/10.2522/ptj.20120016 CrossRefPubMed

Poitras S, Wood KS, Savard J et al (2015) Predicting early clinical function after hip or knee arthroplasty. Bone Joint Res 4:145–151. https://doi.org/10.1302/2046-3758.49.2000417 CrossRefPubMedPubMedCentral

Petis SM, Howard JL, Lanting BA et al (2016) Peri-operative predictors of length of stay following total hip arthroplasty. J Arthroplast (January 22)

Toner A, Wallace G, Rowe J et al (2014) The relationship between pre-operative “timed get up and go”and length of stay in primary elective hip and knee arthroplasty patients. Osteoarthr Cartil 22:S380–S381CrossRef

10.

Sharareh B, Le NB, Hoang MT, Schwarzkopf R (2014) Factors determining discharge destination for patients undergoing total joint arthroplasty. J Arthroplast 29:1355–1358.e1. https://doi.org/10.1016/j.arth.2014.02.001 CrossRef

11.

Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRef

12.

Steiner C, Andrews R, Barrett M, Weiss A (2012) HCUP projections: mobility/orthopedic procedures 2003 to 2012. US Agency for Healthcare Research and Quality, US Agency for Healthcare Research and Quality

13.

Peduzzi P, Concato J, Kemper E et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379CrossRef

14.

Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434CrossRef

15.

Haywood KL, Garratt AM, Fitzpatrick R (2005) Older people specific health status and quality of life: a structured review of self-assessed instruments. J Eval Clin Pract 11:315–327CrossRef

16.

George LK, Ruiz Jr D, Sloan FA (2008) The effects of total hip arthroplasty on physical functioning in the older population. J Am Geriatr Soc 56:1057–1062. https://doi.org/10.1111/j.1532-5415.2008.01685.x CrossRefPubMed

17.

George LK, Ruiz Jr D, Sloan FA (2008) The effects of total knee arthroplasty on physical functioning in the older population. Arthritis Rheum 58:3166–3171. https://doi.org/10.1002/art.23888; 10.1002/art.23888CrossRef

18.

Stratford PW, Kennedy DM, Riddle DL (2009) New study design evaluated the validity of measures to assess change after hip or knee arthroplasty. J Clin Epidemiol 62:347–352. https://doi.org/10.1016/j.jclinepi.2008.06.008 CrossRefPubMed

19.

Hustey FM, Mion LC, Connor JT et al (2007) A brief risk stratification tool to predict functional decline in older adults discharged from emergency departments. J Am Geriatr Soc 55:1269–1274. https://doi.org/10.1111/j.1532-5415.2007.01272.x CrossRefPubMed

20.

Oosting E, Hoogeboom TJ, Appelman-de Vries SA et al (2016) Preoperative prediction of inpatient recovery of function after total hip arthroplasty using performance-based tests: a prospective cohort study. Disabil Rehabil 38:1243–1249. https://doi.org/10.3109/09638288.2015.1076074 CrossRefPubMed

21.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef

22.

American Society of Anaesthesiologists (2014) ASA physical status classification system

23.

Harrison JD, Greysen RS, Jacolbia R, et al (2016) Not ready, not set… discharge: patient-reported barriers to discharge readiness at an academic medical center. J Hosp Med April 15:

24.

Partridge JS, Fuller M, Harari D et al (2015) Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg 18:57–63. https://doi.org/10.1016/j.ijsu.2015.04.037 CrossRefPubMed

25.

McAuley C, Westby MD, Hoens A, et al (2014) A survey of physiotherapists’ experience using outcome measures in total hip and knee arthroplasty. Physiother CanadaPhysiotherapie Canada 66:274–285. doi: https://doi.org/10.3138/ptc.2013-34 CrossRef

26.

Barsoum WK, Murray TG, Klika AK, et al (2010) Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplast 25:885–892. doi: 10.1016/j.arth.2009.06.022CrossRef

27.

Bade MJ, Kohrt WM, Stevens-Lapsley JE (2010) Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 40:559–567. https://doi.org/10.2519/jospt.2010.3317 CrossRefPubMedPubMedCentral

28.

Lubbeke A, Katz JN, Perneger TV, Hoffmeyer P (2007) Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol 34:394–400PubMed

29.

Kennedy DM, Stratford PW, Hanna SE et al (2006) Modeling early recovery of physical function following hip and knee arthroplasty. BMC Musculoskelet Disord 7:100. https://doi.org/10.1186/1471-2474-7-100 CrossRefPubMedPubMedCentral

30.

Jr JAZ, Snyder-Mackler L (2010) Early postoperative measures predict 1- and 2-year outcomes after unilateral total knee arthroplasty: importance of contralateral limb strength. Phys Ther 90:43–54CrossRef

Title: Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful?
Authors: Stéphane Poitras
Kendrick Au
Kristi Wood
Geoffrey Dervin
Paul E. Beaulé
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 10/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3833-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2018

Outcomes of cartilage repair techniques for chondral injury in the hip—a systematic review

Muscle pedicle bone grafting using the anterior one-third of the gluteus medius attached to the greater trochanter for treatment of Association Research Circulation Osseous stage II osteonecrosis of the femoral head

Correction to: Functional outcome following a locked fracture-dislocation of the calcaneus

Single-stage treatment of infected tibial non-unions and osteomyelitis with bone marrow granulocytes precursors protecting bone graft

Total ankle replacement leads to high revision rates in post-traumatic end-stage arthrosis

Computed tomography of bicondylar tibial plateau fractures after distraction with a bridging external fixation