Can Relative Blood Loss and Operative Time Predict Prolonged Length of Stay following Total Joint Arthroplasty? A Retrospective Study from Single Center in Saudi Arabia

Background. Recent evidence suggests benefit to receiving physical therapy (PT) the same day as total joint arthroplasty (TJA), but relatively little is known about barriers to providing PT in this constrained time period. We address the following questions: (1) Are there demographic or perioperative variables associated with receiving delayed PT following TJA? (2) Does receiving immediate PT following TJA affect short-term outcomes such as length of stay, discharge disposition, or 30-day readmission? Methods. Primary TJA procedures at a single center were retrospectively reviewed. Immediate PT was defined as within eight hours of surgery. Demographic and perioperative variables were compared between patients who received immediate PT and those who did not. We identified an appropriately matched control group of patients who received immediate PT. Postoperative length of stay, discharge disposition, and 30-day readmissions were compared between matched groups. Results. In total, 2051 primary TJA procedures were reviewed. Of these, 226 (11.0%) received delayed PT. These patients had a higher rate of general anesthesia (25.2% versus 17.8%, p=0.006), later operative start time (13:26 [11:31-14:38] versus 9:36 [8:24-11:16], p<0.001), longer operative time (1.8 [1.5-2.2] versus 1.6 [1.4-1.8] hours, p=0.002), and higher overall caseload on the day of surgery (6 [4-9] versus 5 [4-8], p=0.002). A matched group of patients who received immediate PT was identified. There were no differences in postoperative length of stay or discharge disposition between matched immediate and delayed PT groups, but delayed PT (OR 4.54; 95% CI 1.61-12.84; p=0.004) was associated with a higher 30-day readmission rate. Conclusion. Barriers to receiving immediate PT following TJA included general anesthesia, later operative start time, longer operative time, and higher daily caseload. These factors present potential targets for improving the delivery of immediate postoperative PT. Early PT may help reduce 30-day readmissions, but additional research is necessary to further characterize this relationship.

Download Full-text

Tranexamic Acid results in Less Blood Loss in Total Joint Arthroplasty: A Retrospective Study

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1094 ◽

2018 ◽

Vol 8 (1) ◽

pp. 43-48

Author(s):

Michael P Bolognesi ◽

Samuel S Wellman ◽

Taylor R McClellan ◽

Rhett Hallows ◽

Kendall E Bradley ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Tranexamic Acid ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty

Download Full-text

CHARACTERISTICS OF DENGUE INFECTION IN SAUDI CHILDREN: SINGLE CENTER RETROSPECTIVE STUDY IN A TERTIARY HOSPITAL IN JEDDAH, WESTERN SAUDI ARABIA

10.26226/morressier.58fa1764d462b80290b509b2 ◽

2017 ◽

Author(s):

Moustafa Hegazi

Keyword(s):

Saudi Arabia ◽

Retrospective Study ◽

Dengue Infection ◽

Tertiary Hospital ◽

Single Center

Download Full-text

Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽

10.3390/geriatrics6010026 ◽

2021 ◽

Vol 6 (1) ◽

pp. 26

Author(s):

Christopher Fang ◽

Andrew Hagar ◽

Matthew Gordon ◽

Carl T. Talmo ◽

David A. Mattingly ◽

...

Keyword(s):

Length Of Stay ◽

Total Joint Arthroplasty ◽

Hospital Costs ◽

Cost Effective ◽

Joint Arthroplasty ◽

Nursing Facilities ◽

Activity Based Costing ◽

Skilled Nursing ◽

Value Based Care ◽

Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

Download Full-text