Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar;11(Suppl 2):S239-S245.
doi: 10.1016/j.jcot.2019.09.009. Epub 2019 Sep 11.

Predictors of extended length of stay after unicompartmental knee arthroplasty

B M Sephton  1 , P Bakhshayesh  1 , T C Edwards  1 , A Ali  1 , V Kumar Singh  1 , D Nathwani  1
Affiliations

Predictors of extended length of stay after unicompartmental knee arthroplasty

B M Sephton et al. J Clin Orthop Trauma. 2020 Mar.

Abstract

Purpose: To identify factors that independently predict extended length of stay after unicompartmental knee arthroplasty (UKA) surgery (defined as length of stay longer than 3 days), and to identify factors predicting early post-operative complications.

Methods: A retrospective analysis of all patients undergoing UKA from January 2016-January 2019 at our institution was performed. Clinical notes were reviewed to determine the following information: Patient age (years), gender, American Society of Anesthesiologists (ASA) grade, weight (kg), height (meters), body mass index (BMI), co-morbidities, indication for surgery, surgeon, surgical volume, surgical technique (navigated or patient-specific instrumentation), implant manufacturer, estimated blood loss (ml), application of tourniquet during the surgery, application of drain, hospital length of stay (days) and surgical complications.

Results: Multivariate regression analysis showed that ASA 3-4 vs. ASA 1-2 [OR 4.4 (CI; 1.8-10.8, p = 0.001)] and a history of cardiovascular disease [OR 2.8 (CI; 1.4-5.5), p = 0.004)] were significant independent predictors of prolonged length of stay. Hosmer-Lemeshow goodness of fit of the model showed a p-value of 0.214. Nagelkerke R-Square was 0.2. For complications, multivariate regression analysis showed that ASA 3-4 vs. ASA 1-2 [OR 5.8 (CI; 1.7-20.7)] and high BMI (BMI >30) [OR 4.3 (CI; 1.1-17.1)] were significant independent predictors of complications. Hosmer-Lemeshow goodness of fit was 0.89 and Nagelkerke R-Square was 0.2. Patients treated with robotics (Navio) techniques had shorter length of stay median 51 h (IQR; 29-96) when compared to other techniques 72 h (IQR; 52-96), p = 0.008.

Conclusion: Based on the results of our study, high ASA grade (≥3) appears to be the most important factor excluding eligibility for fast-track UKA. Any number of co-morbidities may increase ASA, but in and of themselves, apart from a history of cardiovascular disease, they should not be seen as contraindications. Appropriate patient selection, technical tools and details during the surgery could facilitate fast track surgery.

Keywords: Arthroplasty; Knee prosthesis; Length of stay; Morbidity; Risk factors.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
ROC curves representing factors affecting length of stay following UKR.
Fig. 2
Fig. 2
ROC curves representing factors predicting complication following UKR.
See this image and copyright information in PMC

References

    1. Molloy I.B., Martin B.I., Moschetti W.E., Jevsevar D.S. Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013. J Bone Jt Surg - Am. 2017;99(5):402–407. - PMC - PubMed
    1. Burn E., Edwards C.J., Murray D.W. Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014. BMJ Open. 2018;8(1):1–10. - PMC - PubMed
    1. Galbraith A.S., McGloughlin E., Cashman J. Enhanced recovery protocols in total joint arthroplasty: a review of the literature and their implementation. Ir J Med Sci. 2018 Feb 16;187(1):97–109. http://link.springer.com/10.1007/s11845-017-1641-9 (1971 -) [Internet] Available from: - DOI - PubMed
    1. Hoorntje A., Koenraadt K.L.M., Boevé M.G., van Geenen R.C.I. Outpatient unicompartmental knee arthroplasty: who is afraid of outpatient surgery? Knee Surgery. Sport Traumatol Arthrosc. 2017;25(3):759–766. - PMC - PubMed
    1. Kort N.P., Bemelmans Y.F.L., Schotanus M.G.M. Outpatient surgery for unicompartmental knee arthroplasty is effective and safe. Knee Surgery. Sport Traumatol Arthrosc. 2017;25(9):2659–2667. - PubMed