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Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful?

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Abstract

Purpose

Variations in hospital length of stay (LOS) and function are present after hip or knee arthroplasty. Comorbidity and performance measures have been associated with post-operative outcomes. It is however not known if both independently contribute to outcome prediction. The objective of this study was to evaluate the combined predictive ability of comorbidity scores (American Society of Anesthesiologists classification system (ASA), Charlson comorbidity index (CCI), 2008 version of the CCI (CCI08)) and a performance measure (Timed-Up-and-Go (TUG)) on LOS and short-term function in patients undergoing knee or hip arthroplasty.

Methods

One hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively with the ASA, CCI, CCI08, and TUG. LOS was determined through administrative data. The Older Americans Resources and Services ADL questionnaire (OARS) was used to assess function two and six weeks after surgery. Logistic regression was used to assess the relationship between pre-operative assessments and LOS and OARS scores.

Results

Both the ASA and TUG significantly contributed to LOS prediction. Odds ratio (OR) was 3.57 (95% confidence interval (CI) 1.26–10.07) for the ASA, and 2.18 (95% CI 1.67–4.15) for a one-standard deviation (SD) increase of 4.45 s of the TUG. Only the TUG was predictive of two weeks function and trending towards significance for six weeks function. One SD TUG increase yielded an OR of 2.14 (95% CI 1.53–3.79) for two week function.

Conclusions

The TUG and ASA can be used pre-operatively in combination to predict LOS, and TUG can also be used to predict short-term post-operative function.

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Acknowledgements

We would like to acknowledge the contribution of Jae-Jin Ryu for the study coordination, Gillian Parker and Sarah Plamondon for patient recruitment and data collection, Lyne Cuerrier, Jennifer Forget, Yvonne Kossen, Chantale Pryor and Olena Tonkyhk for data collection.

Funding

This work was supported by a grant from The Ottawa Hospital Academic Medical Organization (TOHAMO).

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Authors and Affiliations

  1. School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada

    Stéphane Poitras

  2. Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada

    Kendrick Au, Kristi Wood, Geoffrey Dervin & Paul E. Beaulé

Authors
  1. Stéphane Poitras
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  2. Kendrick Au
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  5. Paul E. Beaulé
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Correspondence to Stéphane Poitras.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from The Ottawa Hospital ethical review board. All patients gave their informed written consent for participation in the study.

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Poitras, S., Au, K., Wood, K. et al. Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful?. International Orthopaedics (SICOT) 42, 2295–2300 (2018). https://doi.org/10.1007/s00264-018-3833-y

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  • DOI: https://doi.org/10.1007/s00264-018-3833-y

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