Analysis Of Risk Factors For Delayed Discharge Following Total Hip Arthroplasty

Objective To investigate the independent risk factors of delayed discharge after total hip arthroplasty(THA),to reveal the influence of patient factors and perioperative factors on the postoperative length of stay,and to analyze the implementation of optimization measures and its improvement plans.Methods Patients,underwent elective unilateral THA in the First Affiliated Hospital of Chongqing Medical University from January 2017 to June 2020,were reviewed.Data including age,sex,BMI,marital status,smoking history,drinking history,comorbidity,ASA grade,diagnosis,preoperative activity of mobility,preoperative length of stay,duration of operation,anesthesia techniques,intraoperative rehydration,intraoperative urine output,intraoperative blood loss,blood transfusion,complications,postoperative analgesia,Clavien-Dindo classification,visual analogue scale for 24 h after operation and mobilization time was extracted.Patients with postoperative length of stay more than median postoperative length of stay were assigned to the delayed discharge group.Chi-square test was used for univariate analysis,and binary logistic regression analysis was used for multivariate analysis.The correlation between clinical data and delayed discharge was analyzed.Result1.756 patients after THA were included.The median postoperative length of stay was 6 days.There were 420 patients in the delayed discharge group(55.6%)and 336 patients in the control group(44.4%).2.Univariate analysis showed that the significant difference was found in age(χ~2=51.774),sex(χ~2=15.736),BMI(χ~2=7.145),marital status(χ~2=6.730),smoking history(χ~2=4.077),drinking history(χ~2=51.6.504),ASA grade(χ~2=25.487),number of comorbidities(χ~2=23.863),preoperative activity of mobility(χ~2=29.868),preoperative length of stay(χ~2=19.212),diagnosis(χ~2=46.427),duration of operation(χ~2=6.144),intraoperative blood loss(χ~2=10.008),blood transfusion(χ~2=6.893),postoperative oral administration of tramadol(χ~2=4.713),Clavien-Dindo classification(χ~2=67.646)and mobilization time(χ~2=33.444)(P<0.05).2.Multivariate analysis showed that age(65 yrs-79 yrs vs <65 yrs,OR=1.561;>79 yrs vs <65 yrs,OR=2.787),hip fracture(OR=1.710),preoperative hospitalstay(4 d-6 d vs <4 d,OR=2.024;>6 d vs <4 d,OR=3.821),intraoperative blood loss > 100 m L(OR=1.773),Clavien-Dindo classification(2 vs <1,OR=2.437;>2 vs 1,OR=7.157),and mobilization >24 h(OR=1.683)were independent risk factors for delayed discharge after THA(P<0.05).Conclusion1.Age and hip fracture were unmodifiable independent risk factors of delayed discharge after THA.Preoperative length of hospital stay,intraoperative blood loss,Clavien-Dindo classification and postoperative mobilization were modifiable independent risk factors of delayed discharge after THA.2.Modifiable independent risk factors need to be intervened early to reduce the incidence of delayed discharge after THA by shortening the preoperative length of stay,enhancing blood protection,promoting early mobilization and positively preventing complications.