title: Day of Surgery and Surgical Start Time Affect Hospital Length of Stay After Total Hip Arthroplasty.
abstract: The United States spends $12 billion each year on ∼332,000 total hip arthroplasty (THA) procedures with the postoperative period accounting for ∼40% of costs. The purpose of this study was to evaluate the effect of surgical scheduling (day of week and start time) on clinical outcomes, hospital length of stay (LOS), and rate of nonhome discharge in THA patients.
  
  
  
  Analysis of perioperative variables was performed for patients who underwent THA at an urban tertiary care teaching hospital from 2009 to 2014.
  
  
  
  A total of 580 THA patients were included for analysis. LOS was higher for the Thursday/Friday cohort compared to Monday/Tuesday (3.7 vs 3.4 days; P = .03). Patients who had a surgical start time after 2 PM had longer LOS compared to patients operated on before 2 PM (3.9 vs 3.5 days; P = .03). After controlling for patient comorbidities and THA surgical approach (direct anterior vs posterior), Thursday/Friday THAs were associated with a 3.27 times risk of extended LOS (>75th percentile LOS) compared to Monday/Tuesday THAs (P < .001). Additionally, case start before 2 PM was protective and associated with a 0.46 times odds of extended LOS (P = .01). LOS reduction opportunity for changing surgical start time to before 2 PM was 0.9 days for high-risk patients (American Society of Anesthesiology class 3/4 and/or liver disease) and 0.2 days for low-risk patients (American Society of Anesthesiology class 1/2).
  
  
  
  Patients who underwent THA Thursday/Friday or had start times after 2 PM had significantly extended hospital LOS. Preoperative risk modification along with adjustments to surgical scheduling and/or perioperative staffing may reduce LOS and thus hospital expenditures for THA procedures.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Aakash
authors.initials: A
authors.lastname: Keswani
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Christina
authors.initials: C
authors.lastname: Beck
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Meier
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Adam
authors.initials: A
authors.lastname: Fields
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bronson
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Calin S
authors.initials: CS
authors.lastname: Moucha
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011184:Postoperative Period
keywords: day of week; extended length of stay; length of stay; surgery start time; surgical scheduling; total hip arthroplasty