title: Not all total joint replacement patients are created equal: preoperative factors and length of stay in hospital.
abstract: BACKGROUND
  We conducted a cross-sectional study of primary total joint replacement (TJR) patients to determine predictors for prolonged length of stay (LOS) in hospital to identify patient characteristics that may inform resource allocation, accounting for patient complexity.
  
  
  METHODS
  Preoperative demographics, medical comorbidities and acute hospital LOS from a consecutive series of primary TJR patients from an academic arthroplasty centre were abstracted. We categorized patients as LOS of 3 or fewer days, 4 days, or 5 or more days to align results with varying LOS benchmarks. To identify predictors for LOS, we used a generalized logistic regression model fitted on an LOS ternary outcome, using LOS of 3 or fewer days as a reference category.
  
  
  RESULTS
  The sample included 1459 patients: 61.7% total knee and 38.3% total hip. Male sex was predictive of an LOS of 3 or fewer days (4 d: odds ratio [OR] 0.48, 95% confidence interval [CI] 0.364-0.631; ≥ 5 d: OR 0.57, 95% CI 0.435-0.758), as was current smoking status (4 d: OR 0.425, 95% CI 0.274-0.659; ≥ 5 d: OR 0.489, 95% CI 0.314-0.762). Strong predictors of prolonged LOS included total hip versus total knee arthroplasty, age 75 years or older, American Society of Anesthesiologists classification of 3 and 4 and number of cardiovascular comorbidities.
  
  
  CONCLUSIONS
  Not all patients undergoing TJR are equal. The goal should be individual patient-focused care rather than a predetermined LOS that is not achievable for all patients. Hospital resource planning must account for patient complexity when planning future bed management.
authors: The Hamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, the Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont.
authors: Mitch
authors: M
authors: Winemaker
authors: The Hamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, Hamilton, Ont.
authors: Danielle
authors: D
authors: Petruccelli
authors: The Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
authors: Conrad
authors: C
authors: Kabali
authors: The Hamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, the Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont.
authors: Justin
authors: J
authors: de Beer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057234:Preoperative Period; D012372:ROC Curve; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects