Predictors of farther mobilization on day of surgery and shorter length of stay after total joint arthroplasty

Predictors of farther mobilization on day of surgery and shorter length of stay after total joint arthroplasty

Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine i...

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Bibliographic Details
Published in:Canadian Journal of Surgery Vol. 63; no. 6; pp. E509 - E516
Main Authors: Gautreau, Sylvia, Haley, Regan, Gould, Odette N, Canales, Donaldo D, Mann, Tara, Forsythe, Michael E
Format: Journal Article
Language:English
Published: Canada Joule Inc 01-12-2020
CMA Impact, Inc
Subjects:
Age Factors
Aged
Arthritis, Rheumatoid - surgery
Arthroplasty, Replacement, Hip - rehabilitation
Arthroplasty, Replacement, Knee - rehabilitation
Body mass index
Bone surgery
Early Ambulation - methods
Early Ambulation - statistics & numerical data
Female
Gender differences
Hospital utilization
Humans
Joint replacement
Joint replacement surgery
Joint surgery
Length of stay
Length of Stay - statistics & numerical data
Male
Methods
Middle Aged
Osteoarthritis, Hip - surgery
Osteoarthritis, Knee - surgery
Patient safety
Physical therapy
Postoperative care
Postoperative Period
Quality control
Retrospective Studies
Sex Factors
Therapeutics, Physiological
Time Factors
Treatment Outcome
Canada
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Summary:Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine if farther mobilization on POD0 led to shorter length of stay and to identify the predictors of farther mobilization and length of stay. A retrospective chart review was undertaken using data for patients who had a primary TJA and mobilized on POD0. Patients were categorized into the following 4 mobilization groups: sat on the bedside (Sat), stood by the bed or walked in place (Stood), walked in the room (Room) and walked in the hall (Hall). The primary outcome was length of stay. Predictors of farther mobilization on POD0 and length of stay were identified using regression analyses. The sample comprised 283 patients. The Hall group had significantly shorter length of stay than all other groups. There were sex differences across the mobilization groups. Simultaneous regression analysis showed that farther mobilization was predicted by younger age, male sex, lower body mass index, spinal anesthesia and fewer symptoms limiting mobilization. Hierarchical regression showed that shorter length of stay was predicted by male sex, lower body mass index, lower American Society of Anaesthesiologists physical status classification score, less pain/stiffness and farther mobilization on POD0. Understanding the modifiable and nonmodifiable predictors of mobilization after TJA and length of stay can help identify patients more likely to mobilize farther on the day of surgery, which would contribute to better resource allocation and discharge planning. Focusing on symptom management could increase opportunities for farther mobilization on POD0 and thereby decrease length of stay.
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ISSN:0008-428X
1488-2310
DOI:10.1503/cjs.003919