Skip to main content
SpringerLink
Log in

Length of stay and its impact upon functional outcomes following lower limb arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim was to investigate the interplay between patient characteristics and (1) length of hospital stay and (2) one-year patient-reported outcome following total knee and hip arthroplasty.

Methods

Event (survival) analysis and structural equation modelling were performed for 1001 patients undergoing knee (n = 566) and hip (n = 435) arthroplasty in a single institution.

Results

Age, body mass index and co-morbidities were independent predictors of length of stay in both event analysis and structural equation modelling. These patient characteristics and type of arthroplasty had both small direct and indirect effects on patient-reported outcome measures at one year. Length of stay had a small effect (<2 %) in SF-36 scores at one year.

Conclusion

Predictors that influence length of stay also impact on one-year post-operative outcome and therefore should be taken into account during patient selection and discharge planning.

Level of evidence

Retrospective cohort study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Antrobus JD, Bryson GL (2011) Enhanced recovery for arthroplasty: good for the patient or good for the hospital? Can J Anaesth 58(10):891–894

    Article  PubMed  Google Scholar 

  2. Archer S, Montague J, Bali A (2014) Exploring the experience of an enhanced recovery programme for gynaecological cancer patients: a qualitative study. Perioper Med (Lond) 3(1):2

    Article  Google Scholar 

  3. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840

    CAS  PubMed  Google Scholar 

  4. Bragstad LK, Kirkevold M, Hofoss D, Foss C (2012) Factors predicting a successful post-discharge outcome for individuals aged 80 years and over. Int J Integr Care 12:4

    Article  Google Scholar 

  5. Gandek B (2015) Measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index: a systematic review. Arthritis Care Res (Hoboken) 67(2):216–229

    Article  Google Scholar 

  6. Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL (2000) Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplast 15(4):448–452

    Article  CAS  Google Scholar 

  7. Higuera CA, Elsharkawy K, Klika AK, Brocone M, Barsoum WK (2011) 2010 Mid-America Orthopaedic Association Physician in Training Award: predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res 469(5):1391–1400

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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):168–173

    Article  PubMed  Google Scholar 

  9. Jonas SC, Smith HK, Blair PS, Dacombe P, Weale AE (2013) Factors influencing length of stay following primary total knee replacement in a UK specialist orthopaedic centre. Knee 20(5):310–315

    Article  PubMed  Google Scholar 

  10. Jones EL, Wainwright TW, Foster JD, Smith JR, Middleton RG, Francis NK (2014) A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery. Ann R Coll Surg Engl 96(2):89–94

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183(6):630–641

    Article  PubMed  Google Scholar 

  12. Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP, Reed MR (2014) Reduced short-term complications and mortality following enhanced recovery primary hip and knee arthroplasty: results from 6000 consecutive procedures. Acta Orthop 85(1):26–31

    Article  PubMed  PubMed Central  Google Scholar 

  13. Machin JT, Phillips S, Parker M, Carrannante J, Hearth MW (2013) Patient satisfaction with the use of an enhanced recovery programme for primary arthroplasty. Ann R Coll Surg Engl 95(8):577–581

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Maradit-Kremers H, Visscher SL, Kremers WK, Naessens JM, Lewallen DG (2014) Obesity increases length of stay and direct medical costs in total hip arthroplasty. Clin Orthop Relat Res 472(4):1232–1239

    Article  PubMed  Google Scholar 

  15. McDonald DA, Siegmeth R, Deakin AH, Kinninmonth AW, Scott NB (2012) An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom-follow up at one year. Knee 19(5):525–529

    Article  CAS  PubMed  Google Scholar 

  16. NHS Group (2013) Enhanced recovery care pathway—a better journey for patients seven days a week and a better deal for the NHS. Progress review 2012/2013. NHS improving quality. http://www.nhsiq.nhs.uk/8846.aspx

  17. NHS Group (2013) The NHS outcomes framework 2014/2015. Department of Health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/256456/NHS_outcomes.pdf

  18. Olthof M, Stevens M, Bulstra SK, van den Akker-Scheek I (2014) The association between comorbidity and length of hospital stay and costs in total hip arthroplasty patients: a systematic review. J Arthroplast 29(5):1009–1014

    Article  Google Scholar 

  19. Paans N, Stevens M, Wagenmakers R, van Beveren J, van der Meer K, Bulstra SK, van den Akker-Scheek I (2012) Changes in body weight after total hip arthroplasty: short-term and long-term effects. Phys Ther 92(5):680–687

    Article  PubMed  Google Scholar 

  20. Ruta DA, Abdalla MI, Garratt AM, Coutts A, Russell IT (1994) SF 36 health survey questionnaire: I. reliability in two patient based studies. Qual Health Care 3(4):180–185

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Savaridas T, Serrano-Pedraza I, Khan SK, Martin K, Malviya A, Reed MR (2013) Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4500 consecutive procedures. Acta Orthop 84(1):40–43

    Article  PubMed  PubMed Central  Google Scholar 

  22. Scott NB, McDonald D, Campbell J, Smith RD, Carey AK, Johnston IG, James KR, Breusch SJ (2013) The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units—an implementation and follow-up at 1 year, 2010–2011: a report from the Musculoskeletal Audit, Scotland. Arch Orthop Trauma Surg 133(1):117–124

    Article  PubMed  Google Scholar 

  23. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  24. Wasielewski RC, Weed H, Prezioso C, Nicholson C, Puri RD (1998) Patient comorbidity: relationship to outcomes of total knee arthroplasty. Clin Orthop Relat Res 356:85–92

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Newcastle Hospitals NHS Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK

    Timothy M. Brock, Michelle Bardgett & David Deehan

  2. South Tees Hospitals, James Cook Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

    Paul N. Baker

  3. Department of Biology, Newcastle University, Devonshire Building, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK

    Steven Rushton

Authors
  1. Timothy M. Brock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul N. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven Rushton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michelle Bardgett
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Deehan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Brock.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

Service evaluation was not required. The project was registered with the institutions audit department (Newcastle Hospitals NHS Foundation Trust, Project Record number 5467) and was conducted in accordance with the Declaration of Helsinki and the guidelines for good clinical practice.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brock, T.M., Baker, P.N., Rushton, S. et al. Length of stay and its impact upon functional outcomes following lower limb arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 2676–2681 (2017). https://doi.org/10.1007/s00167-015-3914-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3914-z

Keywords

Search

Navigation