Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China, 518036.
National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China, 518036.
BMC Musculoskelet Disord. 2023 Jan 4;24(1):6. doi: 10.1186/s12891-022-06107-w.
Total hip arthroplasty (THA) is a successful treatment for many hip diseases. Length of stay (LOS) and hospital cost are crucial parameters to quantify the medical efficacy and quality of unilateral primary THA patients. Clinical variables associated with LOS and hospital costs haven't been investigated thoroughly.
The present study retrospectively explored the contributors of LOS and hospital costs among a total of 452 unilateral primary THA patients from January 2019 to January 2020. All patients received conventional in-house rehabilitation services within our institute prior to discharge. Outcome parameters included LOS and hospital cost while clinical variables included patient characteristics and procedural variables. Multivariable linear regression analysis was performed to assess the association between outcome parameters and clinical variables by controlling confounding factors. Moreover, we analyzed patients in two groups according to their diagnosis with femur neck fracture (FNF) (confine THA) or non-FNF (elective THA) separately.
Among all 452 eligible participants (266 females and 186 males; age 57.05 ± 15.99 year-old), 145 (32.08%) patients diagnosed with FNF and 307 (67.92%) diagnosed with non-FNF were analyzed separately. Multivariable linear regression analysis revealed that clinical variables including surgery duration, transfusion, and comorbidity (stroke) among the elective THA patients while the approach and comorbidities (stoke, diabetes mellitus, coronary heart disease) among the confine THA patients were associated with a prolonged LOS (P < 0.05). Variables including the American Society of Anesthesiologists classification (ASA), duration, blood loss, and transfusion among the elective THA while the approach, duration, blood loss, transfusion, catheter, and comorbidities (stoke and coronary heart disease) among the confine THA were associated with higher hospital cost (P < 0.05). The results revealed that variables were associated with LOS and hospital cost at different degrees among both elective and confine THA.
Specific clinical variables of the patient characteristics and procedural variables are associated the LOS and hospital cost, which may be different between the elective and confine THA patients. The findings may indicate that evaluation and identification of detailed perioperative factors are beneficial in managing perioperative preparation, adjusting patients' anticipation, decreasing LOS, and reducing hospital cost.
全髋关节置换术（THA）是治疗许多髋关节疾病的有效方法。住院时间（LOS）和医院费用是量化单侧初次 THA 患者医疗效果和质量的关键参数。与 LOS 和医院费用相关的临床变量尚未得到充分研究。
本研究回顾性分析了 2019 年 1 月至 2020 年 1 月期间共 452 例单侧初次 THA 患者的 LOS 和医院费用的影响因素。所有患者在出院前均在我院接受常规院内康复服务。结果参数包括 LOS 和医院费用，而临床变量包括患者特征和手术变量。采用多元线性回归分析，在控制混杂因素的情况下，评估结果参数与临床变量之间的关系。此外，我们根据患者是否患有股骨颈骨折（FNF）（限制型 THA）或非 FNF（择期 THA）将患者分为两组进行分析。
在所有 452 名符合条件的参与者中（266 名女性和 186 名男性；年龄 57.05±15.99 岁），145 名（32.08%）患者诊断为 FNF，307 名（67.92%）患者诊断为非 FNF。多元线性回归分析显示，手术时间、输血和合并症（中风）等临床变量与择期 THA 患者的 LOS 延长有关，而手术入路和合并症（中风、糖尿病、冠心病）等临床变量与限制型 THA 患者的 LOS 延长有关（P<0.05）。在择期 THA 患者中，美国麻醉医师协会（ASA）分级、手术时间、失血量和输血等变量与医院费用相关（P<0.05），而在限制型 THA 患者中，手术入路、手术时间、失血量、输血、导尿管和合并症（中风和冠心病）等变量与医院费用相关（P<0.05）。结果表明，在择期和限制型 THA 患者中，不同的临床变量与 LOS 和医院费用之间存在不同程度的关联。
患者特征和手术变量的特定临床变量与 LOS 和医院费用相关，在择期和限制型 THA 患者中可能存在差异。这些发现表明，评估和识别详细的围手术期因素有助于管理围手术期准备、调整患者预期、缩短 LOS 和降低医院费用。
