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Hip: G. F. Dall, N. E. Ohly, J. A. Ballantyne, and I. J. Brenkel The influence of pre-operative factors on the length of in-patient stay following primary total hip replacement for osteoarthritis: A MULTIVARIATE ANALYSIS OF 2302 PATIENTS J Bone Joint Surg Br 2009; 91-B: 434-440 [Abstract] [Full text] [PDF]

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The influence of pre-operative factors on the length of in-patient stay following primary THR

Richard A Boden, Samantha Whitehouse   (15 September 2009)

The influence of pre-operative factors on the length of in-patient stay following primary THR 15 September 2009
Richard A Boden, Orthopaedic Surgeon North Western Deanery, Samantha Whitehouse Send letter to journal: Re: The influence of pre-operative factors on the length of in-patient stay following primary THR rboden{at}doctors.org.uk Richard A Boden, et al.	Sir, We thank the authors for a well written paper with similar findings to a smaller study we presented at the British Orthopaedic Association in Liverpool in 2008. Our study was over a six-month period on 100 consecutive patients after initiation of day of surgery admission and attempts to reduce length of stay (LOS). We found several factors that increased LOS for primary hip and knee surgery patients. Using student t test and ANOVA analysis, we found statistical significance for increasing age, ASA grade, high co-morbidity and living alone. We found a reduction in mean LOS from 8.47 to 5.87 days in under 70-year-olds when compared with those over 70 years (p = 0.0004), having three or more co-morbidities (compared with two or less) increased the mean LOS from 6.61 days to 9.3 days (p = 0.002); ASA grade of 3 increased the mean LOS to 9.56 days; from 6.27 and 6.87 for grade 1 and 2 respectively (p = 0.014) and living alone (compared with cohabiting) increased the mean LOS from 6.55 days to 9.19 days (p = 0.0017). We also found no correlation between LOS and body mass index, in agreement with this and other studies.1,2 Our work has allowed us to target resources towards what we see as an at-risk group of patients with respect to increased LOS. All patients over 70 years undergoing total joint arthroplasty are referred to an occupational therapist and physiotherapist for pre-operative review, allowing approximately 12 weeks for a formal assessment and if needed, a home visit. For patients who live alone or who have greater than two co-morbidities, referral to the therapist is also considered. As we move to a nurse-led pre-operative assessment, set criteria to identify the patient group who will require an increased LOS or will benefit from increased resources, is needed. We are also seeing a trend towards a more elderly population and an associated increase in ASA grade. Powerful and large papers, such as this one will allow surgeons to examine ways of reducing LOS, and where this is not possible, I hope they will allow steering groups to re-examine the tariff system. In the near future, I hope we may see an increased tariff for the elderly undergoing total joint arthroplasty. R.A. Boden, Orthopaedic Surgeon, S. Whitehouse, North Western Deanery, Manchester, UK. 1. Foote J, Panchoo K, Blair P, Bannister G. Length of stay following primary total hip replacement. Ann R Coll Surg Engl 2009;91:500-504. 2. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 2008;79:168-73.