International Orthopaedics

, Volume 36, Issue 8, pp 1601–1608

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

  • Shruti Raut
  • Stephan Christian Mertes
  • Graciela Muniz-Terrera
  • Vikas Khanduja
Original Paper

Abstract

Purpose

The aim of this study was to examine factors associated with a prolonged length of stay (LOS) in patients over 75 undergoing a total knee replacement (TKR).

Methods

Patients over 75 undergoing a TKR at our institution from January 2008 to February 2009 were identified (n = 112). Patient and operative factors previously shown to affect length of stay were identified. Patient notes were reviewed for details on each of these and data analysed for their effect on length of stay. Discrete data were analysed for their effect on post-operative length of stay using either the Mann-Whitney U test or the Kruskall-Wallis test and continuous data analysed with the Spearman’s rank correlation coefficient.

Results

The following factors were associated with length of stay at the 95 % confidence level: patient age, pre-operative mobility and the use of walking aids, BMI, whether the patient was able to mobilise within 24 or 48 hours of the surgery, the day on which the patient first walked ten metres and achieved 90° active knee flexion, pre and post-operative haemoglobin and the need for a blood transfusion.

Conclusions

Pre-operative use of walking aids, peri-operative haemoglobin concentration, failure to mobilise early following the operation and post-operative complications (including the need for a blood transfusion) seem to be the significant factors associated with a prolonged stay in hospital in the over 75 year olds.

References

  1. 1.
    Arden N, Nevitt MC (2006) Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 20:3–25PubMedCrossRefGoogle Scholar
  2. 2.
    Hospital Episodes Statistics Online (2009) Hospital episode statistics. Http://www.hesonline.nhs.uk. Accessed 14 February 2012
  3. 3.
    HM Treasury (2010) Budget 2010: Securing the recovery. Http://www.hm-treasury.gov.uk/budget2010.htm. Accessed 14 February 2012
  4. 4.
    Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, Sexton DJ, Schmader KE (2009) The effect of surgical site infection on older operative patients. J Am Geriatr Soc 57:46–54PubMedCrossRefGoogle Scholar
  5. 5.
    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 79:168–173PubMedCrossRefGoogle Scholar
  6. 6.
    Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130:263–268PubMedCrossRefGoogle Scholar
  7. 7.
    Dauty M, Smitt X, Menu P, Dubois C (2009) Which factors affect the duration of inpatient rehabilitation after total knee arthroplasty in the absence of complications? Ann Phys Rehabil Med 52:234–245PubMedGoogle Scholar
  8. 8.
    Cook JR, Warren M, Ganley KJ, Prefontaine P, Wylie JW (2008) A comprehensive joint replacement program for total knee arthroplasty: a descriptive study. BMC Musculoskelet Disord 9:154PubMedCrossRefGoogle Scholar
  9. 9.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  10. 10.
    Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20:46–50PubMedCrossRefGoogle Scholar
  11. 11.
    Hewitt B, Shakespeare D (2001) Flexion vs. extension: a comparison of post-operative total knee arthroplasty mobilisation regimes. Knee 8:305–309PubMedCrossRefGoogle Scholar
  12. 12.
    Chandrasekaran S, Ariaretnam SK, Tsung J, Dickison D (2009) Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis. ANZ J Surg 79:526–529PubMedCrossRefGoogle Scholar
  13. 13.
    Isaac D, Falode T, Liu P, I’Anson H, Dillow K, Gill P (2005) Accelerated rehabilitation after total knee replacement. Knee 12:346–350PubMedCrossRefGoogle Scholar
  14. 14.
    Larsen K, Sørensen OG, Hansen TB, Thomsen PB, Søballe K (2008) Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 79:149–159PubMedCrossRefGoogle Scholar
  15. 15.
    Paysant J, Jardin C, Biau D, Coudeyre E, Revel M, Rannou F (2008) What is the interest of early knee mobilization after total knee arthroplasty? Ann Readapt Med Phys 51:138–143PubMedCrossRefGoogle Scholar
  16. 16.
    Rosencher N, Ozier Y (2003) Peri-operative use of EPO. Transfus Clin Biol 10:159–164PubMedCrossRefGoogle Scholar
  17. 17.
    Sasanuma H, Sekiya H, Takatoku K, Takada H, Sugimoto N, Hoshino Y (2011) Efficient strategy for controlling post-operative hemorrhage in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:921–925PubMedCrossRefGoogle Scholar
  18. 18.
    Salido JA, Marín LA, Gómez LA, Zorrilla P, Martínez C (2002) Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am 84-A:216–220PubMedGoogle Scholar
  19. 19.
    Guerin S, Collins C, Kapoor H, McClean I, Collins D (2007) Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med 17:37–43PubMedGoogle Scholar
  20. 20.
    Leach D, Bonfe M (2009) The effectiveness of femoral/sciatic nerve blocks on post-operative pain management in total knee arthroplasty. Orthop Nurs 28:257–262PubMedCrossRefGoogle Scholar
  21. 21.
    Duarte VM, Fallis WM, Slonowsky D, Kwarteng K, Yeung CKL (2006) Effectiveness of femoral nerve blockade for pain control after total knee arthroplasty. J Perianesth Nurs 21:311–316PubMedCrossRefGoogle Scholar
  22. 22.
    Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179PubMedCrossRefGoogle Scholar
  23. 23.
    Rissanen P, Aro S, Paavolainen P (1996) Hospital- and patient-related characteristics determining length of hospital stay for hip and knee replacements. Int J Technol Assess Health Care 12:325–335PubMedCrossRefGoogle Scholar
  24. 24.
    Forrest G, Fuchs M, Gutierrez A, Girardy J (1998) Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty. J Arthroplasty 13:186–190PubMedCrossRefGoogle Scholar
  25. 25.
    Liebergall M, Soskolne V, Mattan Y, Feder N, Segal D, Spira S, Schneidman G, Stern Z, Israeli A (1999) Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay. Clin Perform Qual Health Care 7:17–22PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Shruti Raut
    • 1
  • Stephan Christian Mertes
    • 1
  • Graciela Muniz-Terrera
    • 2
  • Vikas Khanduja
    • 1
  1. 1.Department of Trauma and OrthopaedicsAddenbrooke’s – Cambridge University Hospitals NHS Foundation TrustCambridgeUK
  2. 2.MRC Biostatistics Unit, Institute of Public HealthUniversity of CambridgeCambridgeUK

Personalised recommendations