Abstract
ObjectivesTo identify predictors of length of stay (LOS) after total hip arthroplasty (THA) in an enhanced recovery after surgery (ERAS) program and evaluate the safety and cost‐efficiency of the ERAS program with reduced LOS for unselected patients in a Chinese population.MethodsA total of 311 consecutive, unselected patients undergoing primary THA at a single institution were retrospectively reviewed and divided into two groups: LOS ≤ 3 and LOS > 3 group. All patients were managed with the same ERAS protocol and went back home after discharge. Multivariate logistic regression analysis was used to determine independent risk factors for LOS > 3. Harris Hip Score at 90‐day follow‐up, 90‐day readmission rate, and hospitalization costs were compared between two groups.ResultsMultivariate regression analysis identified female gender (odds ratio [OR] = 2.623), living alone (OR = 4.127), and primary osteoarthritis of hip (OR = 3.565) to be correlated with LOS > 3. Preoperative hemoglobin (HB), postoperative HB, drain use, blood transfusion, diabetes, respiratory disease, osteoporosis, number of comorbidities, and CCI score showed no significant influence on LOS after adjusting for other risk factors in the multivariate model. Harris Hip Score and readmission rate at 90‐day follow‐up showed no significant differences between two groups. Patients in LOS > 3 group had approximately 3948.6 Chinese yuan higher hospital costs.ConclusionFemale gender, living alone, and primary osteoarthritis of hip were identified as independent risk factors for prolonged LOS. The experience from our institution suggested aggressive management of comorbidities in the ERAS program can minimize the influence of comorbidities on LOS. The safety, efficiency, and costs‐saving benefits of the ERAS program with reduced LOS for unselected patients was confirmed in this study.
Highlights
Total hip arthroplasty (THA) is the most effective and commonly used procedure for end-stage hip disease
We considered that the predictors for length of stay (LOS) in western literatures may be nonequivalent for those of Chinese patients
Female gender, living alone, and primary osteoarthritis of hip were identified as independent risk factors for LOS > 3
Summary
Total hip arthroplasty (THA) is the most effective and commonly used procedure for end-stage hip disease. The enhanced recovery after surgery (ERAS) program was pioneered by Henrik Kehlet in the 1990s to improve postoperative recovery in gastrointestinal surgery, and satisfactory results were achieved[2]. The ERAS program advocates evidence-based interventions to decrease surgical trauma and stress response by a multimodal approach. It promotes a series of perioperative managements that focus on rapid recovery, reducing postoperative complications, early discharge, reducing costs, and improving patient satisfaction. The ERAS program has recently gained special attention in THA procedure[3].
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