Does the frailty index predict discharge disposition and length of stay at the hospital and rehabilitation facilities?

IntroductionMany geriatric hip fracture patients utilize significant healthcare resources and require an extensive recovery period after surgery. There is an increasing awareness that measuring frailty in geriatric patients may be useful in predicting mortality and perioperative complications and may be useful in helping guide treatment decisions. The primary purpose of the study is to investigate whether the frailty index predicts discharge disposition from the hospital and discharge facility and length of stay.MethodsIn this retrospective cohort study, patients aged 65 years and older presenting to a level 1 trauma center with a hip fracture and a calculated frailty index were eligible for inclusion. The primary outcome was discharge disposition. Secondary outcomes were hospital and discharge facility length of stay, 90-day hospital mortality and readmissions, and return to home.ResultsA total of 313 patients were included. The frailty index was a robust predictor of discharge to a skilled nursing facility (OR 1.440 per 0.1 point increase). Patients with a higher frailty index were at higher risk of 90-day mortality and less likely to return to home at the end of follow-up. There was a very weak correlation between the frailty index and hospital length of stay (ρ=0.30) and rehab length of stay (ρ=0.26).ConclusionThe frailty index can be used to predict discharge destination from both the hospital and rehabilitation facility, 90-day mortality, and return to home after rehabilitation. In this study, the frailty index had a very weak correlation with length of stay in the hospital and in discharge destination. The frailty index can be used to help guide medical decision making, goals of care discussions, and to determine which patients benefit from intensive rehabilitation.     

Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation

Introduction  

Fast-track surgery is the combination of optimized clinical and organizational factors aiming at reducing convalescence and perioperative morbidity including the functional recovery resulting in reduced hospitalization. As the previous nationwide studies have demonstrated substantial variations in length of stay (LOS) following standardized operations such as total hip and knee arthroplasty (THA and TKA), this nationwide study was undertaken to evaluate the implementation process of fast-track THA and TKA in Denmark.     

Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty?

This prospective observational study investigated the relationship between the length of hospital stay (LOS) and outcomes at 3 months for primary total hip arthroplasty for osteoarthritis. Mean length of postoperative stay was 9.5 +/- 2.8 days. Predictors of LOS were patient's age, sex, and number of comorbidities; preoperative Charnley scores and Nottingham Health Profile measures; complications; and hospital in which surgery took place. LOS was found to have a small negative correlation with outcome. The dominant association with improved outcome was the severity of the patients' impairment preoperatively. These data suggest that in situations in which adequate rehabilitation and support are available after discharge, a marginal reduction in postoperative LOS--from the average of 10.3 days observed at 1 hospital to the average of 8 days observed at another--would not adversely affect the short-term outcome.     

Ankylosing spondylitis substantially increases health-care costs and length of hospital stay following total hip arthroplasty – National in-patient database study

IntroductionThe outcome following major arthroplasty surgeries in patients with ankylosing spondylitis (AS) has tremendously improved over the past decades, due to substantial amelioration in the medical therapies and sophistication of available surgical modalities. Although various studies have already demonstrated the complication rates and challenges faced in AS patients undergoing THA, there is a substantial paucity of data on the actual healthcare burden associated with this disease, and the diverse factors which may affect it.MethodsUsing the National Inpatient Sample (NIS) database (on the basis of ICD-10 CMP codes), patients undergoing THA between the years 2016 and 2019 were identified. These patients were then classified into two categories: group A: patients with a known diagnosis of AS; and group N: those without. The details regarding demographical information, associated co-morbidities, data pertaining to patients’ hospital admissions including expenditure incurred, length of stay and complications encountered, were compared. In addition, propensity-score matching was performed to identify a 1:1 matched sample of THA patients without AS.ResultsOverall, 367,890 patients underwent THA; among whom, 501 (0.14%) were known AS patients (group A). Group A included a substantially higher proportion of patients belonging to younger age group (58.6 ± 13.4 versus 65.9 ± 11.4 years; p < 0.001), male sex (67.1% in group A vs 44.1% in group N; p < 0.001), and Asian ethnicity (p < 0.001). Group A patients had a substantially higher risk for longer duration of hospital stay (p < 0.03) and higher overall healthcare expenditure incurred (p < 0.001). As compared to group N, AS patients had a significantly higher risk for developing post-operative anemia [21.8% (group A) vs 11.8% (group N); p < 0.02]; and higher rate of periprosthetic infections [2.4% (group A) vs 1.0% (group N); p < 0.007].ConclusionPatients with AS require a significantly longer duration of hospital stay and higher admission-related expenditure following THA, as compared to the general population. These enhanced early health care-associated costs can be attributed to higher complication rates in AS patients. AS patients are prone to higher rates of anemia and peri-prosthetic infections during the early post-THA period.     

Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection?

We obtained pre-operative and six-month post-operative Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent total hip replacement and 1784 patients who underwent total knee replacement. They all also completed a six-month satisfaction question. Scatter plots showed no relationship between pre-operative Oxford scores and six-month satisfaction scores. Spearman's rank correlation coefficients were -0.04 (95% confidence interval (CI) -0.09 to 0.01) between OHS and satisfaction and 0.04 (95% CI -0.01 to 0.08) between OKS and satisfaction. A receiver operating characteristic (ROC) curve analysis was used to identify a cut-off point for the pre-operative OHS/OKS that identifies whether or not a patient is satisfied with surgery. We obtained an area under the ROC curve of 0.51 (95% CI 0.45 to 0.56) for hip replacement and 0.56 (95% CI 0.51 to 0.60) for knee replacement, indicating that pre-operative Oxford scores have no predictive accuracy in distinguishing satisfied from dissatisfied patients. In the NHS widespread attempts are being made to use patient-reported outcome measures (PROMs) data for the purpose of prioritising patients for surgery. Oxford hip and knee scores have no predictive accuracy in relation to post-operative patient satisfaction. This evidence does not support their current use in prioritising access to care.     

The Injury Severity Score or the New Injury Severity Score for predicting intensive care unit admission and hospital length of stay?

OBJECTIVES: To compare the New Injury Severity Score (NISS) and the Injury Severity Score (ISS) as predictors of intensive care unit (ICU) admission and hospital length of stay (LOS) in an urban North American trauma population and in a subset of patients with head injuries. METHODS: The study population consisted of 23,909 patients from three urban level I trauma centres in the province of Quebec, Canada. The predictive accuracies of the NISS and the ISS were compared using Receiver Operator Characteristic (ROC) curves and Hosmer-Lemeshow (H-L) statistics for the logistic regression model of ICU admission and using r2 for the linear regression model of LOS. RESULTS: A total of 7660 (32%) patients were admitted to the ICU. Mean LOS was 8.2+/-2.5 days. In the whole sample, the NISS presented equivalent discrimination (area under ROC curve: NISS = 0.839 versus ISS = 0.843, p = 0.08) but better calibration (H-L statistic: 309 versus 611) for predicting ICU admission. In the subgroup patients with moderate to serious head injuries, the NISS was a better predictor of ICU admission in terms of both discrimination (area under ROC curve: NISS = 0.771 versus ISS = 0.747, p < 0.00001) and calibration (H-L statistic: 12 versus 21). The NISS explained more variation in LOS than the ISS for the whole sample (r2 = 0.254 versus 0.249, p = 0.0008) and in the sub-population with moderate to severe head injuries (r2 = 0.281 versus 0.263, p = 0.0002). CONCLUSIONS: The NISS is a better choice for case mix control in trauma research than the ISS for predicting ICU admission and LOS, particularly among patients with moderate to severe head injuries.     

Is hospital volume associated with length of stay, re-admissions and reoperations for total hip replacement? A population-based register analysis of 78 hospitals and 54,505 replacements

Introduction

Hospital volume has been suggested to be a significant determinant of the outcome of joint replacement surgery. We updated previously published data on the effect of hospital volume on length of stay, re-admissions, and reoperations for total hip replacement (THR) at the population level in Finland.

Materials and methods

A total of 54,505 THRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into four groups according to the number of primary and revision total hip and knee arthroplasties performed on an annual basis over the whole study period: 1–199 (group 1), 200–499 (group 2), 500–899 (group 3), and >900 (group 4). We analyzed the association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions and reoperations.

Results

The larger the volume group, the shorter were LOS and LUIC (p < 0.01). According to the adjusted data, risk for re-admission in 42 days was greater in group 1 than in group 4 (OR = 1.14; 95 % CI: 1.05–1.23). There was no difference in the risk for reoperation.

Conclusion

LOS and LUIC ought to be shortened in lower volume hospitals.