Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 6, pp 1856–1862

Predictive factors of length of hospital stay after primary total knee arthroplasty

  • Lotte van den Belt
  • Peter van Essen
  • Petra J. C. Heesterbeek
  • Koen C. Defoort
Knee

Abstract

Purpose

To reduce post-operative length of hospital stay (PLOS) after primary total knee arthroplasty (TKA), the fast-track method was introduced which focusses on mobilising the patient within 2 h after surgery. The aim of this prospective study was to identify the factors that predict PLOS using the fast-track method.

Methods

In a consecutive series from July 2012 to November 2012, all patients who were admitted for a primary TKA (Genesis II prosthesis, Smith and Nephew, Memphis, TN) were included in a prospective study. Demographic and relevant preoperative, perioperative and post-operative parameters for PLOS were collected. Multivariate linear regression analysis was performed to identify predictive factors.

Results

In total, 240 patients were included (59.6 % female) with a median age of 64.1 years (range 38–90). Median PLOS was 5 days (range 3–19). The predictive model suggested that ASA score (American Society of Anesthesiologists’ physical status classification) wound exudate and range of motion (ROM) at the day of surgery (day 0) were significant predictive factors for PLOS using the fast-track procedure after TKA (adjusted R2 = 0.43).

Conclusions

Predictive factors for PLOS after TKA were ASA score, wound exudate and ROM at day 0. Adjustments in patient counselling, nursing ward, mode of physiotherapist training and discharge criteria regarding wound exudate may result in a further reduction of post-operative length of hospital stay.

Level of evidence

Prognostic studies: high-quality prospective cohort study, Level I.

Keywords

Post-operative length of stay Fast-track Predictive factors Total knee arthroplasty ASA score Range of motion 

References

  1. 1.
    Amin AK, Patton JT, Cook RE, Brenkel IJ (2006) Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br 88(3):335–340CrossRefPubMedGoogle Scholar
  2. 2.
    Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2008) A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop 79(6):806–811CrossRefPubMedGoogle Scholar
  3. 3.
    Avram V, Petruccelli D, Winemaker M, de Beer J (2014) Total joint arthroplasty readmission rates and reasons for 30-day hospital readmission. J Arthroplasty 29(3):465–468CrossRefPubMedGoogle Scholar
  4. 4.
    Baker P, Petheram T, Jameson S, Reed M, Gregg P, Deehan D (2012) The association between body mass index and the outcomes of total knee arthroplasty. J Bone Joint Surg Am 94(16):1501–1508CrossRefPubMedGoogle Scholar
  5. 5.
    Barbieri A, Vanhaecht K, Van Herck P, Sermeus W, Faggiano F, Marchisio S, Panella M (2009) Effects of clinical pathways in the joint replacement: a meta-analysis. BMC Med 7:32CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Carroll K, Dowsey M, Choong P, Peel T (2013) Risk factors for superficial wound complications in hip and knee arthroplasty. Clin Microbiol Infect 20(2):130–135CrossRefPubMedGoogle Scholar
  7. 7.
    Clement ND, MacDonald D, Howie CR, Biant LC (2011) The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. J Bone Joint Surg Br 93(9):1265–1270CrossRefPubMedGoogle Scholar
  8. 8.
    Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A (2009) Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. Acta Orthop 80(2):213–219CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Healy WL, Iorio R, Ko J, Appleby D, Lemos DW (2002) Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am 84(A(3)):348–353PubMedGoogle Scholar
  10. 10.
    Ho DM, Huo MH (2007) Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations? J Am Coll Surg 205(1):97–100CrossRefPubMedGoogle Scholar
  11. 11.
    Husted H (2012) Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl 83(346):1–39CrossRefPubMedGoogle Scholar
  12. 12.
    Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79(2):168–173CrossRefPubMedGoogle Scholar
  13. 13.
    Husted H, Otte KS, Kristensen BB, Orsnes T, Kehlet H (2010) Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg 130(9):1185–1191CrossRefPubMedGoogle Scholar
  14. 14.
    Ibrahim MS, Alazzawi S, Nizam I, Haddad FS (2013) An evidence-based review of enhanced recovery interventions in knee replacement surgery. Ann R Coll Surg Engl 95(6):386–389CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Jørgensen CC, Kehlet H (2013) Role of patient characteristics for fast-track hip and knee arthroplasty. J Anaesth 110(6):972–980CrossRefGoogle Scholar
  16. 16.
    Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198CrossRefPubMedGoogle Scholar
  17. 17.
    Labraca NS, Castro-Sanchez AM, Mataran-Penarrocha GA, Arroyo-Morales M, Sanchez-Joya M, Moreno-Lorenzo C (2011) Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clin Rehabil 25(6):557–566CrossRefPubMedGoogle Scholar
  18. 18.
    Lindstrom D, Sadr AO, Wladis A, Tonnesen H, Linder S, Nasell H, Ponzer S, Adami J (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248(5):739–745CrossRefPubMedGoogle Scholar
  19. 19.
    Lovald ST, Ong K, Lau E, Joshi G, Kurtz S, Malkani A (2014) Patient selection in outpatient and short-stay total knee arthroplasty. J Surg Orthop Adv 23(1):2–8CrossRefPubMedGoogle Scholar
  20. 20.
    Lovald ST, Ong KL, Malkani AL, Lau EC, Schmier JK, Kurtz SM, Manley MT (2014) Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 29(3):510–515CrossRefPubMedGoogle Scholar
  21. 21.
    Lozano LM, Tió M, Rios J, Sanchez-Etayo G, Popescu D, Sastre S, Basora M (2014) Severe and morbid obesity (BMI ≥ 35 kg/m2) does not increase surgical time and length of hospital stay in total knee arthroplasty surgery. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3002-9
  22. 22.
    Minns Lowe CJ, Barker KL, Dewey M, Sackley CM (2007) Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ 335(7624):812CrossRefPubMedGoogle Scholar
  23. 23.
    Ong PH, Pua YH (2013) A prediction model for length of stay after total and unicompartmental knee replacement. Bone Joint J 95(B(11)):1490–1496CrossRefPubMedGoogle Scholar
  24. 24.
    Raphael M, Jaeger M, van Vlymen VJ (2011) Easily adoptable total joint arthroplasty program allows discharge home in two days. Can J Anaesth 58(10):902–910CrossRefPubMedGoogle Scholar
  25. 25.
    Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E (2002) Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 20(3):506–515CrossRefPubMedGoogle Scholar
  26. 26.
    Schneider M, Kawahara I, Ballantyne G, McAuley C, Macgregor K, Garvie R, McKenzie A, MacDonald D, Breusch SJ (2009) Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty. Arch Orthop Trauma Surg 129(12):1585–1591CrossRefPubMedGoogle Scholar
  27. 27.
    Smith ID, Elton R, Ballantyne JA, Brenkel IJ (2008) Pre-operative predictors of the length of hospital stay in total knee replacement. J Bone Joint Surg Br 90(11):1435–1440CrossRefPubMedGoogle Scholar
  28. 28.
    Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Lotte van den Belt
    • 1
  • Peter van Essen
    • 2
  • Petra J. C. Heesterbeek
    • 2
  • Koen C. Defoort
    • 1
  1. 1.Department of OrthopedicsSint MaartenskliniekNijmegenThe Netherlands
  2. 2.Department of ResearchSint MaartenskliniekNijmegenThe Netherlands

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