AI Article Synopsis
- The study analyzed the effects of converting total knee arthroplasty (TKA) patients from outpatient (OP) to inpatient (IP) status and aimed to identify risk factors leading to this change.
- Among 2,313 patients initially scheduled for OP TKA, 627 (27.1%) ended up requiring an IP stay, with higher discharge rates for IP patients compared to OP.
- Key factors predicting the need for IP status included being over 65, being female, larger body mass index, higher comorbidity scores, and time of surgery, while being married and the first surgery of the day were protective against conversion.
Article Abstract
Background: Removal of total knee arthroplasty (TKA) from the inpatient only list has led to a greater focus on outpatient (OP) procedures. However, the impact of OP-centered models in at-risk patients is unclear. Therefore, the current analysis investigated the effect of conversion from OP to inpatient (IP) status on postoperative outcomes and determined which factors put patients at risk for status change postoperatively.
Methods: We retrospectively reviewed all patients who underwent a primary TKA at our institution between January 2, 2018, and April 26, 2022. All patients included were originally scheduled for OP surgery and were separated based on conversion to IP status postoperatively. Multiple regression analyses were used to determine the significance of all perioperative variables. Modeling via binary logistic regressions was used to determine factors predictive of status conversion.
Results: Of the 2,313 patients originally designated for OP TKA, 627 (27.1%) required a stay of 2 midnights or longer. Patients in the IP group had significantly higher facility discharge rates (P < .001) compared to the OP group. Factors predictive of conversion included age of 65 years and older (P < .001), women (P < .001), arriving at the postanesthesia care unit after 12 pm (P < .001), body mass index greater than 30 (P = .004), and Charlson Comorbidity Index of 4 and higher (P = .004). Being the first case of the day (P < .001) and being married (P < .001) were both protective against conversion.
Conclusion: Certain intrinsic patient factors may predispose a patient to an IP stay, and an understanding of predisposing factors which could lead to IP conversion may improve perioperative planning moving forward.
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| http://dx.doi.org/10.1016/j.arth.2023.04.056 | DOI Listing |
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