Sikora-Klak Jakub, Gupta Andrew, Bergum Christopher, Zarling Bradley, Markel David C
Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; The CORE Institute, Department of Orthopaedics, Southfield, Michigan.
J Arthroplasty. 2017 Apr;32(4):1085-1088. doi: 10.1016/j.arth.2016.10.034. Epub 2016 Nov 16.
The ability to identify those at risk for longer inpatient stay helps providers with postoperative planning and patient expectations. Decreasing length of stay (LOS) in the future will be determined by appropriate patient selection, risk stratification, and preoperative patient optimization. The purpose of this study was to identify factors that place patients at risk for extended postoperative LOSs.
The study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty (THA) patients. Patient comorbidities were prospectively identified and the LOS for each patient was tracked after a primary arthroplasty. Statistical analysis was performed to correlate which comorbidities were associated with longer inpatient stays.
In the TKA population, gender, smoking status, venous thromboembolism history, body mass index, and diabetes status were not found to be a significant predictor for the LOS. Age was found to be a factor in univariate regression testing (P < .001). In the THA population, univariate testing showed female gender (P < .001), smoking status (P = .002), and age (P < .001) to be factors, but like the TKA population, venous thromboembolism history or diabetes status was not significant. In THA multivariate analysis, age (P < .001) and female gender (P = .018) continued to be factors, but smoking was determined to be a confounding variable.
Age and gender were associated with a longer LOS after THA, whereas only age was a significant factor after TKA. Development of age-adjusted LOS models may help aid patient expectations and risk management.
识别那些住院时间较长风险较高的患者的能力有助于医护人员进行术后规划并设定患者预期。未来住院时间的缩短将取决于恰当的患者选择、风险分层以及术前患者状况的优化。本研究的目的是确定使患者术后住院时间延长的风险因素。
研究队列包括2009例初次全膝关节置换术（TKA）患者和905例全髋关节置换术（THA）患者。前瞻性地确定患者的合并症，并在初次关节置换术后跟踪每位患者的住院时间。进行统计分析以关联哪些合并症与更长的住院时间相关。
在TKA患者群体中，未发现性别、吸烟状况、静脉血栓栓塞病史、体重指数和糖尿病状况是住院时间的显著预测因素。在单因素回归测试中发现年龄是一个因素（P < .001）。在THA患者群体中，单因素测试显示女性性别（P < .001）、吸烟状况（P = .002）和年龄（P < .001）是相关因素，但与TKA患者群体一样，静脉血栓栓塞病史或糖尿病状况并不显著。在THA多因素分析中，年龄（P < .001）和女性性别（P = .018）仍然是因素，但吸烟被确定为一个混杂变量。
年龄和性别与THA术后较长的住院时间相关，而在TKA术后只有年龄是一个显著因素。开发年龄调整后的住院时间模型可能有助于设定患者预期和进行风险管理。
