Seddigh Shahriar, Lethbridge Lynn, Theriault Patrick, Matwin Stan, Dunbar Michael J
Department of Orthopaedic Surgery, Nova Scotia Health Authority, Halifax, Canada.
Department of Surgery, Dalhousie University, Halifax, Canada.
Bone Jt Open. 2021 Aug;2(8):679-684. doi: 10.1302/2633-1462.28.BJO-2021-0033.R1.
In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip.
The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and hip arthroplasties (TKA, THA) between 2011 and 2017. Patients waiting longer than the recommended 180 days Canadian national standard were compared to patients waiting equal or less than the standard WT. The primary outcome measure was acute LoS postoperatively. Secondarily, patient demographics, comorbidities, and perioperative parameters were correlated with LoS with multivariate regression.
A total of 11,833 TKAs and 6,627 THAs were included in the study. Mean WT for TKA was 348 days (1 to 3,605) with mean LoS of 3.6 days (1 to 98). Mean WT for THA was 267 days (1 to 2,015) with mean LoS of 4.0 days (1 to 143). There was a significant increase in mean LoS for TKA waiting longer than 180 days (2.5% (SE 1.1); p = 0.028). There was no significant association for THA. Age, sex, surgical year, admittance from home, rural residence, household income, hospital facility, the need for blood transfusion, and comorbidities were all found to influence LoS.
Surgical WT longer than 180 days resulted in increased acute LoS for primary TKA. Meeting a shorter WT target may be cost-saving in a social healthcare system by having shorter LoS. Cite this article: 2021;2(8):679-684.
在加拿大等拥有社会医疗保健系统的国家，患者在手术前可能会经历较长的等待时间，且健康状况会下降。本研究的目的是探讨膝关节和髋关节初次置换术前长时间等待时间（WT）与急性住院时间（LoS）之间的关联。
研究人群来自新斯科舍省省级患者准入登记处（PARNS）和加拿大国家医院出院准入数据库（DAD）。我们纳入了2011年至2017年期间的初次全膝关节和髋关节置换术（TKA、THA）。将等待时间超过加拿大国家标准推荐的180天的患者与等待时间等于或少于标准WT的患者进行比较。主要结局指标是术后急性LoS。其次，通过多变量回归分析患者人口统计学、合并症和围手术期参数与LoS的相关性。
本研究共纳入11,833例TKA和6,627例THA。TKA的平均WT为348天（1至3,605天），平均LoS为3.6天（1至98天）。THA的平均WT为267天（1至2,015天），平均LoS为4.0天（1至143天）。等待时间超过180天的TKA患者的平均LoS显著增加（2.5%（标准误1.1）；p = 0.028）。THA患者则无显著关联。年龄、性别、手术年份、家庭入院、农村居住、家庭收入、医院设施、输血需求和合并症均被发现会影响LoS。
手术WT超过180天会导致初次TKA的急性LoS增加。在社会医疗保健系统中，通过缩短LoS来实现更短的WT目标可能会节省成本。引用本文：2021；2(8):679-684。
