title: Factors associated with longer length of hospital stay after primary elective ankle surgery for end-stage ankle arthritis.
abstract: BACKGROUND
  Longer length of stay in the hospital after elective surgery results in increased use of health-care resources and higher costs. Improved perioperative care permits many foot and ankle surgical procedures to be performed as day surgery. This study determined perioperative factors associated with a longer length of stay after elective total ankle replacement or ankle arthrodesis.
  
  
  METHODS
  Data were prospectively collected on patients who underwent open or arthroscopic ankle fusion or total ankle replacement for end-stage ankle arthritis at our institution from 2003 to 2010. Univariate and multivariable generalized linear regression models with gamma distribution and log link function were conducted with use of the length of the hospital stay as the dependent variable and preselected risk factors of age, sex, physical and mental functional scores, comorbid factors, American Society of Anesthesiologists grade, body mass index, type of surgery, duration of surgery, and surgery day of the week as the independent variables.
  
  
  RESULTS
  This study included 343 patients with a median length of stay of seventy-five hours (interquartile range, fifty-two to ninety-seven hours). With use of regression analyses, the variables of age, female sex, higher American Society of Anesthesiologists grade, multiple medical comorbidities, rheumatoid arthritis, lower Short Form-36 Physical Component Summary and General Health domain scores, and open surgery were significantly associated with increased length of stay. Conversely, the variables of obesity, Short Form-36 Mental Component Summary score, surgery day of the week, and surgical duration were not associated with length of stay. Two predictive models of the length of stay were developed: one included only patient-related factors, and the other included patient and surgery-related factors.
  
  
  CONCLUSIONS
  The patients who are identified with a higher risk of a longer length of stay may warrant better education and more focused perioperative care when designing care pathways and allocating health-care resources.
authors.affiliation: Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, St. Paul's Hospital, Suite 560, 1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada. E-mail address for H. Pakzad: hpakzad@yahoo.com. E-mail address for A. Younger.
authors.forename: Hossein
authors.initials: H
authors.lastname: Pakzad
authors.affiliation: Foot & Ankle Service, Department of Trauma & Orthopaedics, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. E-mail address: xanthus23@hotmail.com.
authors.forename: Gowreeson
authors.initials: G
authors.lastname: Thevendran
authors.affiliation: Department of Orthopaedics, University of British Columbia, Suite 1000, 1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada. E-mail address: penner@vbjc.ca.
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Penner
authors.affiliation: The Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Suite 570, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. E-mail address: hqian@cheos.ubc.ca.
authors.forename: Hong
authors.initials: H
authors.lastname: Qian
authors.affiliation: Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, St. Paul's Hospital, Suite 560, 1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada. E-mail address for H. Pakzad: hpakzad@yahoo.com. E-mail address for A. Younger.
authors.forename: Alastair
authors.initials: A
authors.lastname: Younger
mesh_terms: D017677:Age Distribution; D000843:Ankle Joint; D001168:Arthritis / Q000601:surgery; D001174:Arthrodesis / Q000191:economics* / Q000379:methods / Q000534:rehabilitation; D058737:Arthroplasty, Replacement, Ankle / Q000191:economics* / Q000379:methods / Q000534:rehabilitation; D001955:British Columbia; D017558:Elective Surgical Procedures / Q000191:economics* / Q000379:methods / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019990:Perioperative Care / Q000191:economics / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors