National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
BMJ Open. 2024 Aug 21;14(8):e078108. doi: 10.1136/bmjopen-2023-078108.
Our aim was to identify which patients are likely to stay in hospital longer following total hip replacement surgery.
Longitudinal, observational study used routinely collected data.
Data were collected from an NHS Trust in South-West England between 2016 and 2019.
2352 hip replacement patients had complete data and were included in analysis.
Three measures of length of stay were used: a count measure of number of days spent in hospital, a binary measure of ≤7 days/>7 days in hospital and a binary measure of remaining in hospital when medically fit for discharge.
The mean length of stay was 5.4 days following surgery, with 18% in hospital for more than 7 days, and 11% staying in hospital when medically fit for discharge. Longer hospital stay was associated with older age (OR=1.06, 95% CI 1.05 to 1.08), being female (OR=1.42, 95% CI 1.12 to 1.81) and more comorbidities (OR=3.52, 95% CI 1.45 to 8.55) and shorter length of stay with not having had a recent hospital admission (OR=0.44, 95% CI 0.32 to 0.60). Results were similar for remaining in hospital when medically fit for discharge, with the addition of an association with highest socioeconomic deprivation (OR=2.08, 95% CI 1.37 to 3.16).
Older, female patients with more comorbidities and from more socioeconomically deprived areas are likely to remain in hospital for longer following surgery. This study produced regression models demonstrating consistent results across three measures of prolonged hospital stay following hip replacement surgery. These findings could be used to inform surgery planning and when supporting patient discharge following surgery.
我们旨在确定哪些患者在全髋关节置换手术后住院时间更长。
使用常规收集的数据进行纵向观察性研究。
数据来自英格兰西南部的一家国民保健制度信托基金，收集时间为 2016 年至 2019 年。
2352 例髋关节置换患者数据完整，纳入分析。
使用三种住院时间测量方法：住院天数的计数测量、住院≤7 天/住院>7 天的二分类测量以及在医学上适合出院时仍住院的二分类测量。
手术后平均住院时间为 5.4 天，18%的患者住院时间超过 7 天，11%的患者在医学上适合出院时仍住院。较长的住院时间与年龄较大（OR=1.06，95%CI 1.05 至 1.08）、女性（OR=1.42，95%CI 1.12 至 1.81）和更多合并症（OR=3.52，95%CI 1.45 至 8.55）相关，与近期无住院史相关（OR=0.44，95%CI 0.32 至 0.60）相关。在医学上适合出院时仍住院的情况下，结果类似，增加了与最高社会经济贫困地区的关联（OR=2.08，95%CI 1.37 至 3.16）。
年龄较大、女性患者合并症较多、社会经济贫困地区的患者术后更有可能长时间住院。本研究产生的回归模型在髋关节置换手术后三种延长住院时间的测量中均显示出一致的结果。这些发现可用于为手术计划提供信息，并在手术后支持患者出院。
