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THA performed later in the week led to longer length of stay
Patients who undergo surgery later in the day or on weekends should especially receive physical therapy the same day of surgery.
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A significantly extended length of hospital stay was found among patients who underwent total hip arthroplasty on Thursday or Friday or had a start time after 2 p.m., according to a study.
“Doing joint replacement surgeries earlier in the week and earlier in the day could reduce the hospital length of stay after hip replacement,” Calin S. Moucha, MD, chief of Adult Joint Replacement and Reconstruction at the Mount Sinai Hospital in New York City, told Orthopedics Today.
Length of stay considered
Moucha and his colleagues sorted data for 580 patients who underwent total hip arthroplasty (THA) from 2009 to 2014 into groups based on the day of the week surgery was performed and surgical start time. Overall, researchers analyzed cases from January 2009 through August 2011 with a mini-incision posterior approach, and the direct anterior approach was used in cases from September 2011 onward.
Compared with patients who underwent surgery on Monday or Tuesday, results of bivariate analysis showed a significantly longer length of stay for patients who underwent THA on Thursday or Friday. Researchers identified a longer length of stay among patients who had a surgical start time after 2 p.m. Patients who underwent surgery on Thursday or Friday and patients whose surgery started after 2 p.m. experienced higher rates of extended length of stay.
Researchers found that after controlling for patient characteristics, comorbidities and THA surgical approach, procedures performed on Thursday or Friday had a 3.27-times risk of extended length of stay compared with Monday or Tuesday operations. Results showed a protective effect in surgeries performed before 2 p.m., as well as a 0.46-times odds of extended length of stay. Other significant predictors of extended length of stay included liver disease, American Society of Anesthesiologists class 3 or 4 and direct anterior approach compared with posterior approach.
“After controlling for surgical approach, meaning direct anterior vs. posterior, our results did not change,” Moucha said.
Application of physical therapy
Moucha noted the study did not report on functional outcome measures, so they could not determine the effect of times of day and day of surgery on patient-reported outcomes.
“Based on our study, we recommend all patients undergoing joint replacement surgery should have physical therapy the day of surgery — something we already knew was important for many patients, but that we now know is especially important for patients who have surgery later on in the day or towards the end of the week,” Moucha said. “It is also important to have robust physical therapy in place on weekends for the joint replacement patients that are having surgery later on in the week.”
He also noted, “It is important for hospital administrators to work closely with surgeons and plan the ideal days to do joint replacement surgery, as it can significantly impact length of stay.”– by Casey Tingle
- Reference:
- Keswani A, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2016.04.013.
- For more information:
- Calin S. Moucha, MD, can be reached at 5 E. 98th St., New York, NY 10029; email: ilana.nikravesh@mountsinai.org.
Disclosure: Moucha reports no relevant financial disclosures.