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When can I go home after my knee replacement? Factors affecting the duration of in-hospital stay after knee replacement

  • Vishesh KhannaEmail author
  • A. V. Gurava Reddy
  • Deepesh Daultani
  • Sukesh Rao Sankineani
  • Jai Khanna
  • Adarsh Annapareddy
  • Krishna Kiran Eachampati
Original Article • KNEE - ARTHROPLASTY
  • 41 Downloads

Abstract

Background

Despite a sevenfold decline in the number of postoperative nights (21–3) after a total knee arthroplasty (TKA) over the last four decades, predictors of length of stay (LOS) are not fully understood. We attempted to ascertain these factors by analyzing a large cohort of patients.

Methods

Prospectively collected data between January 2016 and March 2017 were retrospectively analyzed at our institute. Charts of 1663 consecutive, simple primary unilateral and bilateral TKAs were reviewed for the LOS excluding staggered bilateral, complex primary and revision knees. Statistical analysis: Preoperative variables [demographics, cash/credit status, historical, clinical, laboratory findings, Knee Society Function Scores and Oxford Knee Scores (OKSs)] were scrutinized by multivariate regression to identify significant factors affecting LOS and formulate model equations for patients and health caregivers. Results were incorporated into an iOS application, which was tested for accuracy.

Results

Among 1524 unilateral and 139 bilateral TKAs, mean LOS was 4.4 and 5.2 days, respectively. Five factors, namely insurance, flexion/hyperextension deformity, preoperative OKS and a rheumatoid etiology, were significantly associated with prolonged LOS in unilateral knees. The impact of these independent variables on LOS could be calculated by:
$${\text{LOS}} = 5.6 - (0.39 \times {\text{CI}}) + (0.04 \times {\text{FFD}}) - (0.03 \times {\text{PREOPOKS}}) + (0.06 \times {\text{HE}}) - \left( {0.71 \times {\text{ET}}} \right)$$
For bilateral cases, the only significant variable extending LOS was a low preoperative OKS and the equation is given as follows:
$${\text{LOS}} = 7.71 - (0.15 \times {\text{PREOPKS}})$$
The iOS-app-predicted LOS and actual LOS were similar (p > 0.05) for 115 prospectively operated knees.

Conclusion

Poor preoperative OKS, rheumatoid etiology, flexion and hyperextension deformity and delays in insurance affected unilateral TKR LOS, while poor preoperative OKS alone affected LOS in bilateral cases.

Keywords

Length of stay Discharge delays Equations predicting stay Primary total knee arthroplasty Insurance delays Severe deformities 

Notes

Acknowledgements

The authors wish to thank and acknowledge the contributions of Mr. Gautam Goud, our statistician, toward the statistical computation of our data and its analysis. No funds or grants were received toward the conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sunshine HospitalsSecunderabadIndia
  2. 2.New DelhiIndia
  3. 3.San FranciscoUSA
  4. 4.Maxcure HospitalMadhapurIndia

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