Patient vs provider characteristics impacting hospital lengths of stay after total knee or hip arthroplasty

Abstract

This study aims to identify whether patient-level or provider-level characteristics are most influential on a patient's length of stay in the acute care hospital. A data set containing a nationally representative sample of inpatient discharge abstracts was used. Multilevel linear regression models were used to evaluate the associations between patient-level and provider-level characteristics on patients' lengths of stay. The target population included 322,894 discharges with a primary procedure code for primary total knee arthroplasty and 193,553 discharges for total hip arthroplasty. The variables associated with the greatest increases in length of stay were a higher comorbidity level among patient level attributes (+17.4%) and low surgeon volume among provider-level characteristics (+18.8%). Provider-level characteristics, particularly provider volume, had a greater impact on length of stay.

Figure 1

Schema of Case Inclusion and Exclusion The figure is a schematic representation of how the HCUP-NIS data file was pruned to two separate data files consisting of the primary TKR and THR cases. Arrows represent the step by step progression of exclusion, noting the number of cases excluded at each step, prior to obtaining the final set of cases meeting all inclusion and exclusion criteria.