Download PDF
J Knee Surg 2024; 37(01): 043-048
DOI: 10.1055/s-0042-1759791
Original Article

Does Time Spent in the Post-Anesthesia Care Unit Affect Hospital Lengths of Stay following Primary Total Knee Arthroplasty?

Michael J. Sayegh 
1   Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
,
Luke J. Garbarino
1   Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
,
Peter A. Gold
1   Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
,
Hiba K. Anis
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Zhongming Chen 
3   Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Nipun Sodhi
1   Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
,
Jonathan R. Danoff
1   Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
,
Michael A. Mont
3   Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
4   Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Given the current healthcare economic environment, substantial efforts have been made to help streamline the in-hospital care for total knee arthroplasty (TKA) patients. While potential cost-reducing factors have been identified in the literature, analyses specifically considering post-anesthesia care unit (PACU) lengths of stay (LOS) are lacking. Therefore, the purpose of this study was to identify factors associated with (1) longer PACU LOS as well as (2) longer Hospital LOS. Prospectively collected TKA data from seven participating hospitals within a large health system were evaluated for patient demographics, body mass indices, Charlson Comorbidity Indices (CCI), surgeon volumes/training, admission types, anesthesia types, PACU LOS, and overall hospital LOS. Complete data was available for 1,690 patients (1,082 females, mean age: 67 years). Univariate and multivariate analytical models were constructed to identify which factors were predictive of longer PACU and overall hospital LOS. Same-day admissions, higher volume surgeons (≥ 100 cases per year), fellowship-trained arthroplasty surgeons, and longer operative times were associated with longer PACU LOS (p < 0.05). Multivariate analyses found age more than or equal to 65 years (β= 0.124) and CCI more than or equal to 3 (β= 0.088) to be associated with longer hospital LOS (p < 0.001). Operative times, PACU LOS, and procedure times (operative time plus PACU LOS) were not associated with longer hospital LOS (p > 0.05). These data identify associative factors for PACU LOS, as well as the influence of time spent in the PACU on overall hospital LOS. Interestingly, this analysis revealed that patients of arthroplasty fellowship-trained and higher-volume surgeons had longer PACU LOS; however, this could be explained by the observation that these particular surgeons tend to perform more complex deformity cases. Also of importance, increased PACU LOS, meaning the patient spent more time in a high-monitored setting immediately after surgery, did not necessarily confer a longer overall hospital LOS. Based on these data, it may be more beneficial to identify alternate sources than time spent in the operating room or PACU to potentially help reduce overall hospital LOS.

Level of Evidence II, prospective cohort

Keywords

time - post-anesthesia care unit - lengths of stay - total knee arthroplasty


Publication History

Received: 20 January 2022

Accepted: 18 October 2022

Article published online:
31 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 2 Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief 2015; (186) 1-8
    PubMedGoogle Scholar
  • 3 Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services. Final rule. Fed Regist 2015; 80 (226) 73273-73554
    PubMedGoogle Scholar
  • 4 Molloy IB, Martin BI, Moschetti WE, Jevsevar DS. Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013. J Bone Joint Surg Am 2017; 99 (05) 402-407
    CrossrefPubMedGoogle Scholar
  • 5 Chen A, Sabharwal S, Akhtar K, Makaram N, Gupte CM. Time-driven activity based costing of total knee replacement surgery at a London teaching hospital. Knee 2015; 22 (06) 640-645
    CrossrefPubMedGoogle Scholar
  • 6 George J, Mahmood B, Sultan AA. et al. How fast should a total knee arthroplasty be performed? An analysis of 140,199 surgeries. J Arthroplasty 2018; 33 (08) 2616-2622
    CrossrefPubMedGoogle Scholar
  • 7 Belmont Jr PJ, Goodman GP, Hamilton W, Waterman BR, Bader JO, Schoenfeld AJ. Morbidity and mortality in the thirty-day period following total hip arthroplasty: risk factors and incidence. J Arthroplasty 2014; 29 (10) 2025-2030
    CrossrefPubMedGoogle Scholar
  • 8 Belmont Jr PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 2014; 96 (01) 20-26
    CrossrefPubMedGoogle Scholar
  • 9 Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, Della Valle CJ. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty 2018; 33 (07) 2256-2262.e4
    CrossrefPubMedGoogle Scholar
  • 10 Duchman KR, Pugely AJ, Martin CT, Gao Y, Bedard NA, Callaghan JJ. Operative time affects short-term complications in total joint arthroplasty. J Arthroplasty 2017; 32 (04) 1285-1291
    CrossrefPubMedGoogle Scholar
  • 11 Sodhi N, Anis HK, Coste M. et al. A nationwide analysis of preoperative planning on operative times and postoperative complications in total knee arthroplasty. J Knee Surg 2019; 32 (11) 1040-1045
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Sodhi N, Anis HK, Gold PA. et al. Operative times can predict and are correlated with lengths-of-stay in primary total knee arthroplasty: a nationwide database study. J Arthroplasty 2019; 34 (07) 1328-1332
    CrossrefPubMedGoogle Scholar
  • 13 El Bitar YF, Illingworth KD, Scaife SL, Horberg JV, Saleh KJ. Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database. J Arthroplasty 2015; 30 (10) 1710-1715
    CrossrefPubMedGoogle Scholar
  • 14 Halawi MJ, Vovos TJ, Green CL, Wellman SS, Attarian DE, Bolognesi MP. Preoperative predictors of extended hospital length of stay following total knee arthroplasty. J Arthroplasty 2015; 30 (03) 361-364
    CrossrefPubMedGoogle Scholar
  • 15 Rutherford RW, Jennings JM, Dennis DA. Enhancing recovery after total knee arthroplasty. Orthop Clin North Am 2017; 48 (04) 391-400
    CrossrefPubMedGoogle Scholar
  • 16 Aasvang EK, Jørgensen CC, Laursen MB. et al. Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial. Anesthesiology 2017; 126 (06) 1043-1052
    CrossrefPubMedGoogle Scholar
  • 17 Awad IT, Cheung JJ, Al-Allaq Y, Conroy PH, McCartney CJ. Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial. Can J Anaesth 2013; 60 (03) 259-265
    CrossrefPubMedGoogle Scholar
  • 18 Lunn TH, Kristensen BB, Gaarn-Larsen L, Husted H, Kehlet H. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia. Acta Anaesthesiol Scand 2012; 56 (09) 1139-1145
    CrossrefPubMedGoogle Scholar