title: Predictors of Hospital Length of Stay in an Enhanced Recovery After Surgery Program for Primary Total Hip Arthroplasty.
abstract: Shorter length of stay (LOS) for total hip arthroplasty (THA) is becoming standard, yet variables identifying candidates for a 1-day discharge in an enhanced recovery after surgery program are not well defined. With growing emphasis on cost-efficiency and bundled care for THA, this study looked to identify variables that correlated with LOS.
  
  
  
  A retrospective chart review was performed for 273 primary THAs, from April 2014 to January 2015. Clinical measures differentiating a 1-day LOS cohort from that of a LOS longer than 1 day were identified. Direct medical costs were calculated for services billed during hospitalization.
  
  
  
  Logistic regression identified the following preoperative patient characteristics to correlate with an LOS >1 day: older age (odds ratio [OR]: 1.06, P < .001), increased body mass index (OR: 1.06, P = .005), female gender (OR: 1.76, P = .031), American Society of Anesthesiologists score 3 or 4 (OR: 1.84, P = .029), and coronary artery disease (OR: 3.90, P = .013). After adjusting for age, body mass index, and gender, the following perioperative variables led to an LOS ≥2 days: general anesthesia (OR: 2.24, P = .007), longer operative time (OR: 1.04, P < .001), and increased blood loss (OR: 1.01, P = .001). Postoperatively, not ambulating on the day of surgery strongly correlated with an LOS ≥2 days (OR: 3.9, P < .001). Hospital costs were approximately $2900 higher for a 2-day LOS.
  
  
  
  With growing emphasis on cost-efficiency, studying the association of clinical factors with LOS is necessary to develop a preoperative and perioperative predictive risk stratification model that may be used to help optimize discharge protocols for patients in an enhanced recovery after surgery program.
authors.affiliation: Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, Maryland.
authors.forename: Udai S
authors.initials: US
authors.lastname: Sibia
authors.affiliation: Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, Maryland.
authors.forename: James H
authors.initials: JH
authors.lastname: MacDonald
authors.affiliation: Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, Maryland.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: King
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015992:Body Mass Index; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010351:Patient Discharge; D011184:Postoperative Period; D012189:Retrospective Studies; D012737:Sex Factors
keywords: enhanced recovery after surgery; length of stay; perioperative; predictors; preoperative; total hip arthroplasty