Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2019 May;34(5):901-906. doi: 10.1016/j.arth.2018.12.041. Epub 2019 Jan 6.
Many studies have examined strategies to reduce length of stay (LOS) after total hip arthroplasty (THA), but few have focused on modifiable patient-specific information in the acute postoperative period. This study investigates the determinants of LOS after THA, with a focus on potentially modifiable factors.
A total of 1278 patients undergoing elective THA from 2012 to 2014 were extracted from our institutional data warehouse at our academic orthopedic specialty hospital. Data were collected on patient demographics, comorbidities, inpatient opioid use, hypotensive events, and abnormalities in laboratory values, all occurring on postoperative day 0 or 1. The main outcome was hospital LOS. Multivariate regression analysis was performed to identify independent risk factors for LOS over 3 days.
The average age of patients undergoing primary total hip arthroplasty in our cohort was 62.3 (standard deviation 10.7) years, and 52.7% were women. Eighty-one (6.3%) of 1278 patients had a LOS more than 3 days. Multivariate regression analysis demonstrated several statistically significant nonmodifiable and modifiable risk factors that influence LOS after THA. Nonmodifiable risk factors included nonwhite race (odds ratio [OR], 1.497), single marital status (OR, 1.724), increasing age (OR, 1.330), and increasing Charlson Comorbidity Index (OR, 1.411). Potentially modifiable risk factors included every 10 mg oral morphine equivalent consumption (1.069), every 5 postoperative hypotensive events (OR, 1.232), low hemoglobin (OR, 3.265), high glucose levels (OR, 1.887), and a high creatinine (OR, 2.874).
This study identifies potentially modifiable factors that are associated with increased LOS after THA, including postoperative opioid use and hypotensive events. Efforts to control narcotic use and initiatives aimed to reduce early postoperative hypotension could aid in reducing LOS. Furthermore, attempts should be made to correct postoperative anemia, high glucose levels, and a high creatinine level when possible.
许多研究都探讨了降低全髋关节置换术后住院时间（LOS）的策略，但很少关注急性术后可改变的患者特定信息。本研究调查了全髋关节置换术后 LOS 的决定因素，重点关注潜在可改变的因素。
从我们学术骨科专科医院的机构数据仓库中提取了 2012 年至 2014 年间接受择期全髋关节置换术的 1278 名患者的数据。数据收集了患者的人口统计学资料、合并症、住院期间阿片类药物使用、低血压事件和实验室值异常，所有这些都发生在术后第 0 天或第 1 天。主要结果是住院 LOS。进行多变量回归分析以确定 LOS 超过 3 天的独立危险因素。
我们队列中接受初次全髋关节置换术的患者平均年龄为 62.3（标准差 10.7）岁，52.7%为女性。1278 名患者中有 81 名（6.3%）的 LOS 超过 3 天。多变量回归分析显示了几个具有统计学意义的不可改变和可改变的危险因素，这些因素影响全髋关节置换术后的 LOS。不可改变的危险因素包括非白人种族（比值比[OR]，1.497）、单身婚姻状况（OR，1.724）、年龄增加（OR，1.330）和 Charlson 合并症指数增加（OR，1.411）。潜在可改变的危险因素包括每 10 毫克口服吗啡当量消耗（1.069）、每 5 次术后低血压事件（OR，1.232）、低血红蛋白（OR，3.265）、高血糖水平（OR，1.887）和高肌酐（OR，2.874）。
本研究确定了与全髋关节置换术后 LOS 增加相关的潜在可改变因素，包括术后阿片类药物使用和低血压事件。控制阿片类药物使用的努力和旨在减少术后早期低血压的举措可能有助于缩短 LOS。此外，应尽可能纠正术后贫血、高血糖水平和高肌酐水平。
