The Moncton Hospital, Horizon Health Network, Moncton, N.B. (Gautreau, Haley, Gould, Mann, Forsythe); Mount Allison University , Sackville, N.B. (Gould); Research Services, Horizon Health Network, Moncton, N.B. (Canales).
Can J Surg. 2020 Nov-Dec;63(6):E509-E516. doi: 10.1503/cjs.003919.
Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine if farther mobilization on POD0 led to shorter length of stay and to identify the predictors of farther mobilization and length of stay.
A retrospective chart review was undertaken using data for patients who had a primary TJA and mobilized on POD0. Patients were categorized into the following 4 mobilization groups: sat on the bedside (Sat), stood by the bed or walked in place (Stood), walked in the room (Room) and walked in the hall (Hall). The primary outcome was length of stay. Predictors of farther mobilization on POD0 and length of stay were identified using regression analyses.
The sample comprised 283 patients. The Hall group had significantly shorter length of stay than all other groups. There were sex differences across the mobilization groups. Simultaneous regression analysis showed that farther mobilization was predicted by younger age, male sex, lower body mass index, spinal anesthesia and fewer symptoms limiting mobilization. Hierarchical regression showed that shorter length of stay was predicted by male sex, lower body mass index, lower American Society of Anaesthesiologists physical status classification score, less pain/stiffness and farther mobilization on POD0.
Understanding the modifiable and nonmodifiable predictors of mobilization after TJA and length of stay can help identify patients more likely to mobilize farther on the day of surgery, which would contribute to better resource allocation and discharge planning. Focusing on symptom management could increase opportunities for farther mobilization on POD0 and thereby decrease length of stay.
全关节置换术（TJA）当天的动员与住院时间较短有关。手术当天（POD0）是否进一步动员是否有助于缩短住院时间的问题尚未得到广泛研究。本研究的目的是确定 POD0 时更远的动员是否导致住院时间缩短，并确定更远动员和住院时间的预测因素。
使用接受 POD0 动员的初次 TJA 患者的数据进行回顾性图表审查。患者被分为以下 4 个动员组：坐在床边（Sat）、床边站立或原地站立（Stood）、在房间内行走（Room）和在大厅行走（Hall）。主要结局是住院时间。使用回归分析确定 POD0 时更远动员和住院时间的预测因素。
样本包括 283 名患者。Hall 组的住院时间明显短于所有其他组。动员组之间存在性别差异。同时回归分析表明，年轻、男性、较低的体重指数、脊柱麻醉和较少的限制动员症状预测更远的动员。分层回归显示，男性、较低的体重指数、较低的美国麻醉医师协会身体状况分类评分、较少的疼痛/僵硬和 POD0 时更远的动员预测住院时间更短。
了解 TJA 后动员和住院时间的可改变和不可改变预测因素可以帮助识别更有可能在手术当天进行更远动员的患者，从而有助于更好地分配资源和制定出院计划。关注症状管理可以增加 POD0 时更远动员的机会，从而缩短住院时间。
