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
