Zikos Dimitrios, Shrestha Ashara, Colotti Taylor, Fegaras Leonidas
School of Health Sciences, Central Michigan University, Mt. Pleasant, MI 48859, USA.
Computer Science Department, University of Texas at Arlington, Arlington, TX 76019, USA.
Healthcare (Basel). 2019 Apr 6;7(2):58. doi: 10.3390/healthcare7020058.
Hip replacement is the most common surgical procedure among Medicare patients in the US and worldwide. The hospital length of stay (LOS) for hip replacement admissions is therefore important to be controlled, contributing to savings for hospitals. This study combined medical claims and hospital structure and service data to examine LOS fluctuations and trends, and admission distribution patterns, during weekdays, for hip replacement cases. The study furthermore examined associations of these patterns with the LOS performance. Most hospitals were found to admit hip replacement cases at the start of the week (Monday through Wednesday). There is an upward LOS trend as we approach late weekday admissions. Multiple linear regression analysis showed that LOS weekday inconsistencies, a large proportion of hip replacement admissions on Thursday and Friday, the government ownership status, the bed size, and the critical access status are associated with an increased LOS. On the other hand, the rate of hip replacement admissions over total ones, and the hospital being accredited, are associated with a lower LOS. Findings stress out the need for hospitals to maintain an effective and balanced distribution of hip replacement admissions, evenly during the week, and the need for standardized case management, to avoid practice variability and, therefore, LOS fluctuations for their hip replacement cases.
髋关节置换术是美国和全球医疗保险患者中最常见的外科手术。因此，控制髋关节置换术住院患者的住院时间（LOS）对于医院节省开支很重要。本研究结合医疗索赔以及医院结构和服务数据，以检查工作日期间髋关节置换病例的住院时间波动和趋势以及入院分布模式。该研究还检查了这些模式与住院时间表现之间的关联。研究发现，大多数医院在一周开始时（周一至周三）接收髋关节置换病例。随着工作日后期入院时间的临近，住院时间呈上升趋势。多元线性回归分析表明，工作日住院时间不一致、周四和周五髋关节置换入院病例占比大、政府所有制状态、床位规模和急救状态与住院时间延长有关。另一方面，髋关节置换入院病例占总病例的比例以及医院获得认证与较短的住院时间有关。研究结果强调，医院需要在一周内保持髋关节置换入院病例的有效和均衡分布，以及进行标准化的病例管理，以避免医疗实践的差异，从而避免髋关节置换病例的住院时间波动。
