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DOI: 10.1055/s-0043-1772174
Activity Measure for Postacute Care “6-Clicks” Mobility Scores Predict Length of Stay Following Hip Resurfacing
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Abstract
No studies have identified length of stay (LOS) predictors following hip resurfacing arthroplasty (HRA). The activity measure for postacute care (AM-PAC) score is a readily available tool that may allow physicians to predict LOS in patients undergoing HRA. We retrospectively reviewed patients who underwent HRA between February 2017 and April 2021. All patients completed AM-PAC mobility score on postoperative day 0. Age, American Society of Anesthesiology class, body mass index, surgical time, and Charlson comorbidity index were included as possible predictors of LOS. Predictive models were generated predictive for LOS times of more than 24 and more than 48 hours. Analysis was used to determine c. We identified 262 male patients who completed AM-PAC scores following HRA. Patients with a LOS more than 24 hours had significantly lower AM-PAC scores than patients with a LOS less than 24 hours (23.43 ± 1.37 vs. 19.76 ± 2.78; p < 0.001). Similarly, patients with a LOS more than 48 hours had significantly lower AM-PAC scores than patients with a LOS less than 48 hours (22.08 ± 2.56 vs. 18.17 ± 2.23; p < 0.001). AM-PAC scores were 84.5% accurate for predicting LOS more than 24 hours and 86.3% for LOS more than 48 hours. Patients with scores less than 23 were at higher risk for LOS more than 24 hours and less than 19 were likely to have a LOS more than 48 hours. AM-PAC scores following HRA were predictive of LOS. Providers may use the cutoffs in this analysis to determine how mobility influences LOS following HRA. This is a Level III evidence, retrospective cohort study.
Keywords
total hip arthroplasty - hip resurfacing arthroplasty - AM-PAC - length of stay - postoperative period - Youden's JPublication History
Received: 28 July 2022
Accepted: 28 June 2023
Article published online:
09 August 2023
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References
- 1 Kishida Y, Sugano N, Nishii T, Miki H, Yamaguchi K, Yoshikawa H. Preservation of the bone mineral density of the femur after surface replacement of the hip. J Bone Joint Surg Br 2004; 86 (02) 185-189
- 2 Smolders JM, Hol A, Rijnders T, van Susante JL. Changes in bone mineral density in the proximal femur after hip resurfacing and uncemented total hip replacement: a prospective randomised controlled study. J Bone Joint Surg Br 2010; 92 (11) 1509-1514
- 3 Domb BG, Bheem R, Monahan PF. et al. Minimum five-year outcomes of hip resurfacing: propensity-score matched against total hip arthroplasty control groups. J Arthroplasty 2021; 36 (06) 2012-2015
- 4 Bisschop R, Boomsma MF, Van Raay JJAM, Tiebosch ATMG, Maas M, Gerritsma CLE. High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg Am 2013; 95 (17) 1554-1560
- 5 Malviya A, Holland JP. Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience. Acta Orthop Belg 2009; 75 (04) 477-483
- 6 Mont MA, Ragland PS, Etienne G, Seyler TM, Schmalzried TP. Hip resurfacing arthroplasty. J Am Acad Orthop Surg 2006; 14 (08) 454-463
- 7 Kirkland PA, Barfield WR, Demos HA, Pellegrini Jr VD, Drew JM. Optimal length of stay following total joint arthroplasty to reduce readmission rates. J Arthroplasty 2020; 35 (02) 303-308.e1
- 8 Ani L, Anoushiravani AA, Feng JE. et al. Safety and efficacy of same-day hip resurfacing. Orthopedics 2020; 43 (06) e595-e600
- 9 Harry M, Woehrle T, Renier C, Furcht M, Enockson M. Predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ short forms on discharge disposition and effect on readmissions: a retrospective observational cohort study. BMJ Open 2021; 11 (01) e044278
- 10 Haley SM, Coster WJ, Andres PL. et al. Activity outcome measurement for postacute care. Med Care 2004; 42 (01) I49-I61
- 11 Menendez ME, Schumacher CS, Ring D, Freiberg AA, Rubash HE, Kwon YM. Does “6-Clicks” day 1 postoperative mobility score predict discharge disposition after total hip and knee arthroplasties?. J Arthroplasty 2016; 31 (09) 1916-1920
- 12 Hadad MJ, Orr MN, Emara AK, Klika AK, Johnson JK, Piuzzi NS. PLAN and AM-PAC “6-Clicks” scores to predict discharge disposition after primary total hip and knee arthroplasty. J Bone Joint Surg Am 2022; 104 (04) 326-335
- 13 Prommik P, Tootsi K, Saluse T, Strauss E, Kolk H, Märtson A. Simple Excel and ICD-10 based dataset calculator for the Charlson and Elixhauser comorbidity indices. BMC Med Res Methodol 2022; 22 (01) 4
- 14 Jette DU, Stilphen M, Ranganathan VK, Passek SD, Frost FS, Jette AM. Validity of the AM-PAC “6-Clicks” inpatient daily activity and basic mobility short forms. Phys Ther 2014; 94 (03) 379-391
- 15 Jette DU, Stilphen M, Ranganathan VK, Passek S, Frost FS, Jette AM. Interrater reliability of AM-PAC “6-Clicks” basic mobility and daily activity short forms. Phys Ther 2015; 95 (05) 758-766
- 16 Lakomkin N, Kothari P, Dodd AC. et al. Higher Charlson comorbidity index scores are associated with increased hospital length of stay after lower extremity orthopaedic trauma. J Orthop Trauma 2017; 31 (01) 21-26
- 17 Junger A, Klasen J, Benson M. et al. Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol 2001; 18 (05) 314-321
- 18 McDonald MR, Sathiyakumar V, Apfeld JC. et al. Predictive factors of hospital length of stay in patients with operatively treated ankle fractures. J Orthop Traumatol 2014; 15 (04) 255-258
- 19 Maradit Kremers H, Visscher SL, Kremers WK, Naessens JM, Lewallen DG. Obesity increases length of stay and direct medical costs in total hip arthroplasty. Clin Orthop Relat Res 2014; 472 (04) 1232-1239
- 20 Gholson JJ, Noiseux NO, Otero JE, Gao Y, Shah AS. Patient factors systematically influence hospital length of stay in common orthopaedic procedures. Iowa Orthop J 2017; 37: 233-237
- 21 Petis SM, Howard JL, Lanting BA, Somerville LE, Vasarhelyi EM. Perioperative predictors of length of stay after total hip arthroplasty. J Arthroplasty 2016; 31 (07) 1427-1430
- 22 Otero JE, Gholson JJ, Pugely AJ, Gao Y, Bedard NA, Callaghan JJ. Length of hospitalization after joint arthroplasty: does early discharge affect complications and readmission rates?. J Arthroplasty 2016; 31 (12) 2714-2725
- 23 Frassanito L, Vergari A, Nestorini R. et al. Enhanced Recovery After Surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery. Musculoskelet Surg 2020; 104 (01) 87-92
- 24 Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y. et al; Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surg 2020; 155 (04) e196024
- 25 Gaillard-Campbell MD, Fowble C, Webb L, Gross TP. Hip resurfacing as an outpatient procedure: a comparison of overall cost and review of safety. Musculoskelet Surg 2021; 105 (01) 111-116
- 26 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
- 27 Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191
- 28 Domb BG, Bheem R, Monahan PF. et al. Minimum five-year outcomes of hip resurfacing: propensity-score matched against total hip arthroplasty control groups. J Arthroplasty 2021; 36 (06) 2012-2015
- 29 Morse KW, Premkumar A, Zhu A, Morgenstern R, Su EP. Return to sport after hip resurfacing arthroplasty. Orthop J Sports Med 2021; 9 (05) 23 259671211003521
- 30 Nunley RM, Della Valle CJ, Barrack RL. Is patient selection important for hip resurfacing?. Clin Orthop Relat Res 2009; 467 (01) 56-65