Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

Christoffer C Jørgensen, Kirill Gromov, Pelle B Petersen, Henrik Kehlet, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Christoffer C Jørgensen, Kirill Gromov, Pelle B Petersen, Henrik Kehlet, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

Abstract

Background and purpose - Enhanced recovery programs have reduced length of stay (LOS) after hip and knee arthroplasty (THA/TKA). Although risk factors disposing to prolonged LOS are well documented, there is limited information on the role of weekday of surgery. This study analyzed the role of weekday of surgery and other potential risk factors for LOS > 2 days.Patients and methods - We included 10,576 unselected consecutive procedures between January 2016 and August 2017 within a multicenter fast-track THA/TKA collaboration with prospective collection of preoperative characteristics. We used multiple regression analysis of potential risk factors for LOS > 2 days followed by construction of a simple risk score from 0 to 15 points based on the calculated odds ratios.Results - Mean LOS was 1.9 (SD 1.8) days, with 80% of patients having surgery from Monday to Wednesday. Of these, 17% (95% CI 16-18) had a LOS > 2 days vs. 19% (CI 17-21) in those operated on Thursday and Friday. Patients were scheduled evenly throughout the week regardless of risk of LOS > 2 days and despite the fact that 38% (CI 35-40) of patients with ≥ 6 points (16% of the total population) had a LOS > 2 days compared with 14% (CI 13-14) in those with < 6 points. In these "high-risk" patients, the fraction with LOS > 2 days increased when having surgery on Thursdays or Fridays (43% CI 38-49) compared with Monday to Wednesday (37% CI 34-39).Interpretation - A detailed preoperative risk assessment may be helpful to plan the weekday of surgery in order to decrease LOS and weekend hospitalization.

Trial registration: ClinicalTrials.gov NCT01515670.

Figures

Figure 1.
Figure 1.
Study population. THA – total hip arthroplasty, TKA – total knee arthroplasty.
Figure 2.
Figure 2.
Distribution of procedures and day of discharge according to weekday. There were 11 (0.1%) procedures on Saturday and Sunday, all in patients with

Figure 3.

Distribution of patients with length…

Figure 3.

Distribution of patients with length of stay (LOS) > 2 days and 2 days.

Figure 3.
Distribution of patients with length of stay (LOS) > 2 days and 2 days.

Figure 4.

Distribution of procedures on each…

Figure 4.

Distribution of procedures on each weekday according to number of points for LOS…

Figure 4.
Distribution of procedures on each weekday according to number of points for LOS > 2 days.
Figure 3.
Figure 3.
Distribution of patients with length of stay (LOS) > 2 days and 2 days.
Figure 4.
Figure 4.
Distribution of procedures on each weekday according to number of points for LOS > 2 days.

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Source: PubMed

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