Health Policy and EconomicsDay of Surgery and Surgical Start Time Affect Hospital Length of Stay After Total Hip Arthroplasty
Section snippets
Methods
The institutional review board approved this retrospective study. Medical records for all patients undergoing elective THA by 1 fellowship-trained, experienced orthopedic surgeon at an urban, tertiary care hospital from 2009 to 2014 were reviewed. All patients had the same general selection of implants during the 5-year period including DePuy Summit stems, DePuy Pinnacle shells, and Biolox ceramic heads (typically 36 mm) on highly cross-linked polyethylene. Cases from January 2009 through
Results
A total of 580 THA patients were included for analysis, of which 307 received DAA and 273 PA. Patients were divided into groups based on day of week (Monday/Tuesday vs Thursday/Friday) and time of day (before 2 PM vs after 2 PM) the surgery was performed. Patient demographics were generally consistent across these groups (Table 1); however, those operated on after 2 PM were more likely to have a body mass index greater than 40 (P = .003) and chronic obstructive pulmonary disease (P = .03)
Discussion
Given the increase in demand for THA and Medicare's CJR mandating bundled payments for primary THA, the care team (including clinical and nonclinical members from the inpatient, postacute, and primary care settings) must identify strategies to improve the value (outcomes divided by cost) of THA across the care cycle 5, 7. Modifiable patient and provider factors are prime targets for these care redesign efforts. Our study aimed at (1) evaluating the effect of day of the week of surgery and time
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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.04.013.