Key result
Chronic alcohol consumption (OR 2.939), cardiac comorbidities (OR 2.559), advanced age, higher BMI, prolonged surgery, and need for transfusion significantly increased the risk of a hospital stay longer than 7 days following fast-track hip arthroplasty.
Why the study?
Fast track programs reduce perioperative complication rates and accelerate recovery, but patient characteristics and independent factors that influence their success in hip arthroplasty required identification.
Do specific patient characteristics and surgical factors increase the risk of prolonged hospitalization in patients undergoing fast-track hip arthroplasty?
Case-Control (n=1,138)
No
Do specific patient characteristics and surgical factors increase the risk of prolonged hospitalization in patients undergoing fast-track hip arthroplasty?
Advanced age, cardiac comorbidities, chronic alcohol consumption, high BMI, longer surgery time, and need for blood transfusion are significant risk factors for prolonged hospitalization following fast-track hip arthroplasty.
Answers are grounded in this paper and cite their sources.
Patient factors linked to prolonged stay after hip arthroplasty; hypothesis-generating for fast-track optimization, needs prospective validation.
Fast track programs have been introduced to reduce perioperative complication rates and to quickly reintegrate the patient into everyday life. The aim of this retrospective case-control study was to identify patient characteristics and patient-independent factors that influence fast track programs in hip arthroplasty. A total of 1138 patients were examined. A hospital stay of more than seven days was used to define the case group. In addition to the causes for the longer hospitalisation, age, sex, BMI, chronic nicotine and alcohol abuse, ASA score, surgical duration, anaemia and blood transfusion as well as concomitant diseases were assessed. The statistical analysis included two-sample t-test, chi-square test and logistic regression analyses. An 95% confidence interval was calculated (p<0.05). 16.9% of patients could not leave the hospital on the seventh day. The main causes were delayed wound healing (69.4%), increased CRP (43.0%>100 mg/l), and internal complications (19.7%). At a mean of 69.2 ± 10.7 years, the age of the case group was significantly higher than that of the control group, which had a mean of 63.3 ± 10.3 years (p<0.001). Cardiac comorbidities (p<0.001), BMI (p=0.023), and alcohol consumption (p<0.001) increased the risk for longer hospitalisation. Significant patient-independent factors were duration of the surgery (p<0.001) and transfusion (p<0.001). Successful application of fast-track hip arthroplasty is possible for every patient. However, longer hospi- talisation and delayed discharge must be taken into account for patients with advanced age, cardiac comorbidities, alcohol consumption, and high BMI.
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Radetzki et al. (2021) conducted a case-control in Primary total hip replacement (n=1,138). Risk factors (e.g., chronic alcohol consumption, cardiac comorbidities) vs. Absence of risk factors was evaluated on Hospital stay of more than 7 days (OR 2.939, 95% CI 1.560-5.538, p=0.001). Chronic alcohol consumption (OR 2.939), cardiac comorbidities (OR 2.559), advanced age, higher BMI, prolonged surgery, and need for transfusion significantly increased the risk of a hospital stay longer than 7 days following fast-track hip arthroplasty.
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