Predictors of Hospital Length of Stay in an Enhanced Recovery After Surgery Program for Primary Total Hip Arthroplasty

Abstract

BackgroundShorter length of stay (LOS) for total hip arthroplasty (THA) is becoming standard, yet variables identifying candidates for a 1-day discharge in an enhanced recovery after surgery program are not well defined. With growing emphasis on cost-efficiency and bundled care for THA, this study looked to identify variables that correlated with LOS. MethodsA retrospective chart review was performed for 273 primary THAs, from April 2014 to January 2015. Clinical measures differentiating a 1-day LOS cohort from that of a LOS longer than 1 day were identified. Direct medical costs were calculated for services billed during hospitalization. ResultsLogistic regression identified the following preoperative patient characteristics to correlate with an LOS >1 day: older age (odds ratio [OR]: 1.06, P < .001), increased body mass index (OR: 1.06, P = .005), female gender (OR: 1.76, P = .031), American Society of Anesthesiologists score 3 or 4 (OR: 1.84, P = .029), and coronary artery disease (OR: 3.90, P = .013). After adjusting for age, body mass index, and gender, the following perioperative variables led to an LOS ≥2 days: general anesthesia (OR: 2.24, P = .007), longer operative time (OR: 1.04, P < .001), and increased blood loss (OR: 1.01, P = .001). Postoperatively, not ambulating on the day of surgery strongly correlated with an LOS ≥2 days (OR: 3.9, P < .001). Hospital costs were approximately $2900 higher for a 2-day LOS. ConclusionWith growing emphasis on cost-efficiency, studying the association of clinical factors with LOS is necessary to develop a preoperative and perioperative predictive risk stratification model that may be used to help optimize discharge protocols for patients in an enhanced recovery after surgery program.