Is there a relation between length of stay and early complications rate after total knee arthroplasty? Results of 1065 patients

Abstract

Introduction The number of total knee replacements is rapidly increasing as a result of population ageing. Trying to decrease the costs associated with this procedure, there is an increased effort to diminish hospital length of stay without raising the complications rates. Aim Evaluate if there is a relationship between a decrease in hospital's length of stay and early complications within 30 days postoperatively and all-cause readmissions within 30 days after discharge. Material and methods Retrospective revision of 1065 patients submitted to total knee arthroplasty between July 2007 and June 2013 in our institution. Data was collected by analyzing patient's records, in what regards early complications and readmissions within the first 30 days after discharge and the length of stay in hospital after surgery. The statistical analysis was performed using SPSS v22. Significance was defined as P Resultats The population of the study is composed of 1065 patients. The length of stay decreased from 5.18 ± 2.28 days between July 1st 2007 and September 31st 2007, to 4.76 ± 3.2 days between April 1st 2013 and June 30th 2013. Observed complications were 49 (4.6%), with 19 (1.8%) infectious events, 10 (0.9%) suture dehiscences, 9 (0.8%) hemorrhagic events, 3 (0.3%) thromboembolic events, 3 (0.3%) gastrointestinal events, 1 (0.1%) periprosthetic fracture, 1 (0.1%) miocardial infarction, 1 (0.1%) acute renal failure, 1 (0.1%) patellar tendon rupture, 2 (0.2%) deaths. All-cause readmission rate within 30 days after discharge was 6.1%. Discussion There is a decrease in the total length of stay. This is due to the current trend about decreasing hospital length of stay after TKA and positive feedback from the Rehabilitation department. It can be observed a low rate of complications in what concerns DVT, hemorrhagic events and other events like gastrointestinal or renal, which reinforces the confidence of safe earlier discharges. The infection and DVT rates are low when considering the published literature. There are limitations in what concerns the time frame, it is a short postoperative period. Hospital records always have the limitation of underreporting these events. The association between length of stay and early complications rate was not significant (P = 0.2019) as well as all-cause readmission rate (P = 0.280). Conclusion It was not found any significant association between length of stay and both early complications rate and all-cause readmission rate. These findings are similar to other studies and reinforce the current trend about short stays after total knee replacements, which is better for patient safety and cost control.