scholarly journals The impact of the COVID-19 pandemic on the length of stay following total hip and knee arthroplasty in a high volume elective orthopaedic unit

2021 ◽  
Vol 2 (8) ◽  
pp. 655-660
Author(s):  
Gemma Green ◽  
Sarah Abbott ◽  
Yiannis Vyrides ◽  
Irrum Afzal ◽  
Deiary Kader ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Postoperative Rehabilitation ◽  
Time To Surgery ◽  
Hip And Knee Arthroplasty ◽  
The Impact

Aims Elective orthopaedic services have had to adapt to significant system-wide pressures since the emergence of COVID-19 in December 2019. Length of stay is often recognized as a key marker of quality of care in patients undergoing arthroplasty. Expeditious discharge is key in establishing early rehabilitation and in reducing infection risk, both procedure-related and from COVID-19. The primary aim was to determine the effects of the COVID-19 pandemic length of stay following hip and knee arthroplasty at a high-volume, elective orthopaedic centre. Methods A retrospective cohort study was performed. Patients undergoing primary or revision hip or knee arthroplasty over a six-month period, from 1 July to 31 December 2020, were compared to the same period in 2019 before the COVID-19 pandemic. Demographic data, American Society of Anesthesiologists (ASA) grade, wait to surgery, COVID-19 status, and length of hospital stay were recorded. Results A total of 1,311 patients underwent hip or knee arthroplasty in the six-month period following recommencement of elective services in 2020 compared to 1,527 patients the year before. Waiting time to surgery increased in post-COVID-19 group (137 days vs 78; p < 0.001). Length of stay also significantly increased (0.49 days; p < 0.001) despite no difference in age or ASA grade. There were no cases of postoperative COVID-19 infection. Conclusion Time to surgery and length of hospital stay were significantly higher following recommencement of elective orthopaedic services in the latter part of 2020 in comparison to a similar patient cohort from the year before. Longer waiting times may have contributed to the clinical and radiological deterioration of arthritis and general musculoskeletal conditioning, which may in turn have affected immediate postoperative rehabilitation and mobilization, as well as increasing hospital stay. Cite this article: Bone Jt Open 2021;2(8):655–660.

scholarly journals Pre-operative patient education reduces length of stay after knee joint arthroplasty

2011 ◽  
Vol 93 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Samantha Jones ◽  
Mustafa Alnaib ◽  
Michail Kokkinakis ◽  
Michael Wilkinson ◽  
Alan St Clair Gibson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Care Pathway ◽  
Length Of Hospital Stay ◽  
Active Role ◽  
Conventional Group ◽  
Revision Knee Arthroplasty ◽  
Education Group ◽  
The Impact

INTRODUCTION The aim of this study was to evaluate the impact of a pre-operative education programme on length of hospital stay after surgery for primary and revision knee arthroplasty patients. The programme was introduced at our hospital in October 2006 to encourage patients to play an active role in their recovery process after surgery. PATIENTS AND METHODS A multidisciplinary team educated knee arthroplasty patients about their care pathway, knee surgery, pain management, expected discharge goals, in-patient and out-patient arthroplasty rehabilitation. Prospective data were collected from 472 consecutive patients who underwent (primary or revision) knee arthroplasty in the period between January 2006 and November 2007. Patients were separated into two groups, one that received conventional pre-operative treatment (n = 150; Conventional group) and another that received the pre-operative education (n = 322; Education group). Length of hospital stay was compare using the Mann Whitney U test. In-patient complications, hospital re-admissions within 24 h and 3 months of hospital discharge were compared using the chi-squared test. RESULTS The mean length of stay was significantly reduced from 7 days in the Conventional group to 5 days in the Education group (P < 0.01). In addition, 20% more patients were discharged early (within 1–4 days) in the Education group compared to the Conventional group (P < 0.01). There was no difference in the percentage of in-patient complications and re-admissions in 24 h (P = 1.00) and 3 months of discharge (P = 0.92) between the two groups. CONCLUSIONS The results suggest that pre-operative education is a safe and effective method of reducing length of stay for knee arthroplasty patients.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management

2018 ◽  
Vol 29 (2) ◽  
pp. 172-176
Author(s):  
Siu-Wai Choi ◽  
Frankie K L Leung ◽  
Tak-Wing Lau ◽  
Gordon T C Wong
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Medical Complications ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Length ◽  
The Impact ◽  
Postoperative Haemoglobin

Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

scholarly journals Day of surgery: the impact on patient length of stay in a tertiary vascular unit

2020 ◽  
Vol 102 (2) ◽  
pp. 98-103 ◽  
Author(s):  
NC Holford ◽  
C Ní Ghuidhir ◽  
L Hands
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Support Services ◽  
Length Of Hospital Stay ◽  
Abdominal Aortic Aneurysm Repair ◽  
Significant Difference ◽  
Postoperative Length ◽  
The Difference ◽  
Aneurysm Repair ◽  
The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

scholarly journals Can point-of-care testing shorten hospitalization length of stay? An exploratory investigation of infectious agents using regression modelling

2018 ◽  
Vol 25 (4) ◽  
pp. 1606-1617
Author(s):  
Eliona Gkika ◽  
Anna Psaroulaki ◽  
Yannis Tselentis ◽  
Emmanouil Angelakis ◽  
Vassilis S Kouikoglou
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay ◽  
Laboratory Diagnosis ◽  
Final Diagnosis ◽  
Point Of Care Testing ◽  
The Mean ◽  
The Impact

This retrospective study investigates the potential benefits from the introduction of point-of-care tests for rapid diagnosis of infectious diseases. We analysed a sample of 441 hospitalized patients who had received a final diagnosis related to 18 pathogenic agents. These pathogens were mostly detected by standard tests but were also detectable by point-of-care testing. The length of hospital stay was partitioned into pre- and post-laboratory diagnosis stages. Regression analysis and elementary queueing theory were applied to estimate the impact of quick diagnosis on the mean length of stay and the utilization of healthcare resources. The analysis suggests that eliminating the pre-diagnosis times through point-of-care testing could shorten the mean length of hospital stay for infectious diseases by up to 34 per cent and result in an equal reduction in bed occupancy and other resources. Regression and other more sophisticated models can aid the financing decision-making of pilot point-of-care laboratories in healthcare systems.

scholarly journals Effect of individual patient risk, centre, surgeon and anaesthetist on length of stay in hospital after cardiac surgery: Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) consecutive cases series study of 10 UK specialist centres

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016947 ◽  
Author(s):  
Olympia Papachristofi ◽  
Andrew A Klein ◽  
John Mackay ◽  
Samer Nashef ◽  
Nick Fletcher ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Treatment Options ◽  
Length Of Hospital Stay ◽  
Principal Component ◽  
Risk Profile ◽  
Patient Risk ◽  
Substantial Impact ◽  
The Impact

ObjectivesTo determine the relative contributions of patient risk profile, local and individual clinical practice on length of hospital stay after cardiac surgery.DesignTen-year audit of prospectively collected consecutive cardiac surgical cases. Case-mix adjusted outcomes were analysed in models that included random effects for centre, surgeon and anaesthetist.SettingUK centres providing adult cardiac surgery.Participants10 of 36 UK specialist centres agreed to provide outcomes for all major cardiac operations over 10 years. After exclusions (duplicates, cases operated by more than one consultant, deaths and procedures for which the EuroSCORE risk score for cardiac surgery is not appropriate), there were 107 038 cardiac surgical procedures between April 2002 and March 2012, conducted by 127 consultant surgeons and 190 consultant anaesthetists.Main outcome measureLength of stay (LOS) up to 3 months postoperatively.ResultsThe principal component of variation in outcomes was patient risk (represented by the EuroSCORE and remaining patient heterogeneity), accounting for 95.43% of the variation for postoperative LOS. The impact of the surgeon and centre was moderate (intra-class correlation coefficients ICC=2.79% and 1.59%, respectively), whereas the impact of the anaesthetist was negligible (ICC=0.19%). Similarly, 96.05% of the variation for prolonged LOS (>11 days) was attributable to the patient, with surgeon and centre less but still influential components (ICC=2.12% and 1.66%, respectively, 0.17% only for anaesthetists). Adjustment for year of operation resulted in minor reductions in variation attributable to surgeons (ICC=2.52% for LOS and 2.23% for prolonged LOS).ConclusionsPatient risk profile is the primary determinant of variation in LOS, and as a result, current initiatives to reduce hospital stay by modifying consultant performance are unlikely to have a substantial impact. Therefore, substantially reducing hospital stay requires shifting away from a one-size-fits-all approach to cardiac surgery, and seeking alternative treatment options personalised to high-risk patients.

scholarly journals Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment

2014 ◽  
Vol 2 (52) ◽  
pp. 1-178 ◽  
Author(s):  
Céline Miani ◽  
Sarah Ball ◽  
Emma Pitchforth ◽  
Josephine Exley ◽  
Sarah King ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Length Of Hospital Stay ◽  
Theory Of Change ◽  
Local Context ◽  
Health Economy ◽  
Local Health ◽  
The Impact

BackgroundAvailable evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay.ObjectivesThis study sought to (i) describe the nature of interventions that have been used to reduce length of stay in acute care hospitals; (ii) identify the factors that are known to influence length of stay; and (iii) assess the impact of interventions on patient outcomes, service outcomes and costs.Data sourcesWe searched MEDLINE (Ovid), EMBASE, the Health Management Information Consortium and System for Information on Grey Literature in Europe for the period January 1995 to January 2013 with no limitation of publication type.MethodsWe conducted a rapid evidence synthesis of the peer-reviewed literature on organisational interventions set in or initiated from acute hospitals. We considered evidence published between 2003 and 2013. Data were analysed drawing on the principles of narrative synthesis. We also carried out interviews with eight NHS managers and clinical leads in four sites in England.ResultsA total of 53 studies met our inclusion criteria, including 19 systematic reviews and 34 primary studies. Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways. Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.LimitationsWe only considered assessments of interventions which provided a quantitative estimate of the impact of the given organisational intervention on length of hospital stay. There was a general lack of robust evidence and poor reporting, weakening the conclusions that can be drawn from the review.ConclusionsThe design and implementation of an intervention seeking to reduce (directly or indirectly) the length of stay in hospital should be informed by local context and needs. This involves understanding how the intervention is seeking to change processes and behaviours that are anticipated, based on the available evidence, to achieve desired outcomes (‘theory of change’). It will also involve assessing the organisational structures and processes that will need to be put in place to ensure that staff who are expected to deliver the intervention are appropriately prepared and supported. With regard to future research, greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes. There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings. Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation. Full economic costing should be undertaken where possible, including considering the cost implications for the wider local health economy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery

2021 ◽  
Vol 103-B (1) ◽  
pp. 56-64
Author(s):  
Bélène Podmore ◽  
Andrew Hutchings ◽  
John A. Skinner ◽  
Alexander J. MacGregor ◽  
Jan van der Meulen
Keyword(s):  
Heart Disease ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Length Of Hospital Stay ◽  
Safety Risks ◽  
Related Quality ◽  
Hip And Knee Arthroplasty ◽  
Health Related ◽  
Mean Differences ◽  
The Impact

Aims Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. Methods In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality). Results Patients with comorbidities had a longer LOS and higher readmission and mortality rates than patients without. In hip arthroplasty patients with heart disease, for example, LOS was 1.20 days (95% confidence interval (CI) 1.15 to 1.25) longer and readmission rate was 1.52% (95% CI 1.34% to 1.71%) and mortality 0.19% (95% CI 0.15% to 0.23%) higher. Similar patterns were observed for knee arthroplasty patients. Patients without comorbidities reported large improvements in function (mean improvement OHS 21.3 (SD 9.91) and OKS 15.9 (SD 10.0)). Patients with comorbidities reported only slightly smaller improvements. In patients with heart disease, mean improvement in OHS was 0.39 (95% CI 0.27 to 0.51) and in OKS 0.56 (95% CI 0.45 to 0.67) less than in patients without comorbidities. There were no significant differences in EQ-5D improvement. Conclusion Comorbidities were associated with small increases in adverse safety risks but they have little impact on pain or function in patients undergoing hip or knee arthroplasty. These results do not support restricting access to hip and knee arthroplasty for patients with common comorbidities. Cite this article: Bone Joint J 2021;103-B(1):56–64.

Sign in / Sign up

Export Citation Format

Share Document