Preoperative pain level and patient expectation predict hospital length of stay after total hip arthroplasty.

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2015-04

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Abstract

The purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A retrospective review of 112 consecutive patients was performed. High preoperative pain level and patient expectation of discharge to extended care facilities (ECFs) were the only significant multivariable predictors of hospitalization extending beyond 2 days (P=0.001 and P<0.001 respectively). Patient expectation remained significant after adjusting for Medicare's 3-day requirement for discharge to ECFs (P<0.001). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a concordance index of 0.857.

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10.1016/j.arth.2014.10.033

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Halawi, Mohamad J, Tyler J Vovos, Cindy L Green, Samuel S Wellman, David E Attarian and Michael P Bolognesi (2015). Preoperative pain level and patient expectation predict hospital length of stay after total hip arthroplasty. J Arthroplasty, 30(4). pp. 555–558. 10.1016/j.arth.2014.10.033 Retrieved from https://hdl.handle.net/10161/10287.

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Scholars@Duke

Green

Cynthia Lea Green

Associate Professor of Biostatistics & Bioinformatics

Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods

Wellman

Samuel S. Wellman

Associate Professor of Orthopaedic Surgery

My career has primarily focused on clinical care of hip and knee arthritis.  I run a busy Adult Reconstruction (hip and knee replacement) practice.  I am also Chief of the Orthopedic Surgery service at the Durham VA medical center.  In these roles, I work daily with orthopedic residents, and train them to manage these issues both non-operatively and with surgery.   I also mentor residents, fellows,and medical students on their research projects, typically in collaboration with my clinical partner, Michael Bolognesi, MD.  We often have multiple residents working on a variety of projects at once.  My research interests lie mainly with clinical research in hip and knee replacement, including biomechanical studies, outcomes research, and clinical trials. I have also begun collaborating with basic science colleagues on biomarker research

Attarian

David Edward Attarian

Professor of Orthopaedic Surgery

Investigation of value based healthcare markets and transitions. Cost transparency for patients and providers.
Risk management and medicolegal aspects of orthopaedic practice.
Co-management and alignment relationships between clinicians and hospitals/ health systems in evolving healthcare markets.
Clinical outcomes of total hip and knee replacements (primary and revision surgeries, total joint infections, modern bearing surfaces, gait mechanics and balance).
Novel surgical techniques for difficult adult hip and knee reconstruction cases.
Development of quality and efficiency metrics in an Academic practice; correlation of work culture with patient satisfaction and experience.
Development of value based compensation plans for physcians.
Effect of comorbidities on surgical outcomes and complications: anemia, diabetes, smoking, obesity, depression-anxiety

Bolognesi

Michael Paul Bolognesi

Virginia Flowers Baker Distinguished Professor of Orthopaedic Surgery

As chief of the adult reconstruction service, the majority of my research effort has been directed toward clinical outcomes, implant survivorship, functional recovery, the biology of hip and knee arthritis and cost effectiveness.


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