Predicting patients requiring discharge to post-acute care facilities following primary total hip replacement: Does anesthesia type play a role? - 10/10/18
Abstract |
Study objective |
We sought to develop a predictive model for discharge to post-acute care facilities in patients undergoing unilateral total hip replacement (THR). Furthermore, we sought to determine if the use of neuraxial anesthesia was an important covariate for the predictive model.
Design |
Retrospective observational study.
Setting |
Preoperative care and operating room at a single institution.
Patients |
Patients (n = 960) who underwent an elective primary THR between 2014 and 2016.
Interventions |
No intervention was performed.
Measurements |
We collected variables that were known preoperatively including age, sex, body mass index (BMI), preoperative opioid use, functional status based on metabolic equivalents (METS), preoperative anemia, thrombocytopenia, osteoarthritis and contralateral osteoarthritis grade, anesthesia type, comorbidities and surgical approach. We then performed multivariable logistic regression to develop a predictive model.
Main results |
Female sex, preoperative opioid use, older age, general anesthesia, anemia, hypertension, a psychiatric diagnosis, use of dialysis, metabolic equivalents <4 and obesity are all risk factors for a post-acute facility discharge. The use of general anesthesia compared to neuraxial anesthesia was associated with increased odds (odds ratio 1.98, 95% confidence interval 1.31–3.00, p = 0.001) for post-acute facility discharge. Model performance was assessed using ten-fold cross-validation - the average area under the receiver operating characteristic curve calculated was 0.794.
Conclusions |
We developed a predictive model for post-acute care facility discharge following THR. The use of neuraxial anesthesia was associated with decreased odds for post-acute care facility discharge.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Post discharge charges can contribute to almost 30% of total THR costs. |
• | The use of general anesthesia for THR had twice increased odds of discharge to a post-acute care facility |
• | Anesthetic choice and pre-operative patient optimization can contribute significantly to patients’ outcomes after THR. |
Keywords : Discharge location, Skilled nursing facility, Neuraxial anesthesia, Total hip replacement, Predictive model
Plan
Vol 51
P. 32-36 - décembre 2018 Retour au numéro
Article précédent
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