Predictors of prolonged hospital stays following hip and knee arthroplasty

Orthopaedic leaders face extraordinary pressures in a world of diminishing resources, aging baby boomers and escalating demands for hip and knee replacement surgeries. Never has the need for focused, proactive care to improve outcomes and avoid unnecessary hospital days been greater. In this study, risk factors associated with prolonged length of stay (LOS) were investigated for hip and knee arthroplasty patients. An Arthroplasty Optimization Risk Screening Tool (AORST) was designed by an interdisciplinary team to detect patients at risk for prolonged hospital stays. One hundred and fifty patients completed the AORST prior to surgery. A chart audit was done postoperatively to investigate reasons for prolonged stay. Logistic regression statistics were employed to examine predictive associations between the risk variables and LOS. Age over 80, living alone, two or more comorbidities and language barriers were factors associated with prolonged stays. These factors help inform program focus. Interventions can be targeted to address preventable risks early in the pre-surgical phase, so that patients arrive for surgery better prepared and in optimal condition for a smooth recovery. The prevalence of these factors may also help explain variances in LOS among hospital sites, providing a better understanding of the catchment population and the resources required.