Sunday, June 7, 2015

Total shoulder joint replacement arthroplasty - predictors of length of hospital stay - the 4 Ps

Here we have two articles on the same topic using two different national databases.
The first is
Predictors of extended length of stay after elective shoulder arthroplasty.

These authors used the 2011 Nationwide Inpatient Sample, to identify an estimated 40,869 patients who underwent elective total shoulder arthroplasty (62.5% anatomic total shoulder arthroplasty (ATSA)  37.5% reverse total shoulder arthroplasty (RTSA)  and separated them into those with normal length of stay (<75th percentile) and prolonged length of stay (>75th percentile). 

Patient-level factors associated with prolonged length of stay common to patients undergoing ATSA or RTSA included increasing age, female sex, congestive heart failure, renal failure, chronic pulmonary disease, and preoperative anemia. Provider-related factors were lower volume and location in the South or Northeast. Postoperative complications showed a significant influence as well.
The second is
Predictors of length of stay after elective total shoulder arthroplasty in the United States.

These authors isolated 2004 patients undergoing primary unilateral total shoulder arthroplasty (TSA) between 2005 and 2011 from the National Surgical Quality Improvement Program database.

Mean length of stay after TSA was 2.2 days (standard deviation, 1.7), and 91% of cases received hospital discharge in <3 days. Multivariable logistic regression analysis identified renal insufficiency (OR, 11.35; P = .0002), increased age (OR, 2.13; P = .011), longer operative time (OR, 1.94; P = .0041), and American Society of Anesthesiologists class ≥3 (OR, 1.86; P = .0016) as the most significant risk factors for length of stay. Women were more likely to stay ≥4 days (OR, 0.44; P < .0001).

Comment: Once again the importance of the 4 Ps is emphasized. In these papers the Patient-related factors were highly significant: age, comorbidities, female sex, and ASA class. Physician-related factors were lower case volume, location in the South or Northeast and longer operative time.

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