Assessment of the Risk Factors Related to the Length of Hospital Stay and Postoperative Complications in Patients Undergoing Primary Total Knee Arthroplasty

Oliveira, Filipe Marques de; Costa, Lauro Augusto Veloso; Bastos, Angelo Mártyres Pedreira de Albuquerque; Paião, Isabela Dias; Ferretti, Mário; Lenza, Mário

doi:10.1055/s-0042-1753533

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Revista Brasileira de Ortopedia

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Original Article • Rev Bras Ortop 58 (3) • May-Jun 2023 • https://doi.org/10.1055/s-0042-1753533 copy

Assessment of the Risk Factors Related to the Length of Hospital Stay and Postoperative Complications in Patients Undergoing Primary Total Knee Arthroplasty

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the risk factors involving longer hospital stays and early postoperative complications (first 30 days after surgery) in patients undergoing total knee arthroplasty (TKA).

Materials and Methods

Across-sectional study was conducted with collection of data of patients who underwent TKA in a private hospital between 2015 and 2019. The following data were collected: age, gender, body mass index, and clinical comorbid-ities. We also collected intraoperative data such as the grade on the classification of the American Society of Anesthesiologists (ASA), the duration of the surgery, the length of stay, the postoperative complications, and readmission within 30 days. Statistical models were used to investigate the possible risk factors associated with longer hospital stays and postoperative complications.

Results

There was evidence of an increase in the length of hospital stay in older patients, with higher grades on the ASA classification or who suffered postoperative complications. For each increase in 1 year of age, we expect the length of stay to be multiplied by 1.008 (95% confidence interval [95%CI]: 1.004 to 1.012; p < 0,001). In patients who were ASA grade III, the time is expected to be multiplied by 1.297 (95%CI: 1.083 to 1.554; p = 0,005) when compared with grade-I patients. In patients who suffered postoperative complications, the time is expected to be multiplied by 1.505 (95%CI: 1.332 to 1.700; p < 0.001) compared with patients without complications.

Conclusion

The present study demonstrated that, in patients who underwent primary TKA, preoperative characteristics such as older age and ASA grade > III, as well as the development of postoperative complications, independently predict the increase in the length of hospital stay.

arthroplasty; replacement; knee; outcome assessment; postoperative complications; length of stay

	Mean ± standard deviation	n(%)
Gender
Female		348 (66.0%)
Male		179 (34.0%)
Age (years)	70.3 ± 8.9
Body mass index (kg/m²)	29.1 ± 4.7
Comorbidities
Arterial hypertension		234 (44.4%)
Diabetes mellitus		85 (16.1%)
Behavioral disorders		70 (13.3%)
Smoking		18 (3.4%)
Previous cancer diagnosis		34 (6.5%)
Heart disease		59 (11.2%)
Grade on the ASA classification
I		41 (7.8%)
II		438 (83.1%)
III		35 (6.6%)
IV		1 (0.2%)
No Information		12 (2.3%)
Operative time (hours)	2.5 ± 0.7
Length of stay (days)	4.4 ± 2.4
Postoperative complications
No		472 (89.6%)
Yes		39 (7.4%)
No information		16 (3.0%)
Readmission within 30 days
No		524 (99.4%)
Yes		3 (0.6%)

	Lenght of stay# (95%CI)	Odds ratio (95%CI)	p-value
Gender
Female	4.17 (3.98-4.36)	1.053 (0.975-1.138)	0.191
Male	3.96 (3.72-4.22)	1.00	—
Age	—	1.008 (1.004-1.012)	< 0.001
Age by subgroup
< 59 years	3.96 (3.53-4.45)	1.00	—
60 to 69 years	3.73 (3.51-3.98)	0.943 (0.826-1.076)	0.382
70 to 79 years	4.20 (3.98-4.44)	1.062 (0.934-1.206)	0.359
> 80 years	4.98 (4.53-5.47)	1.257 (1.082-1.460)	0.003
BMI (kg/m²)	—	0.996 (0.988-1.004)	0.352
BMI by subgroup
Low weight/Normal weight	4.14 (3.81-4.51)	1.00	—
Overweight	4.19 (3.95-4.44)	1.011 (0.912-1.120)	0.835
Grade-1 obesity	3.92 (3.67-4.19)	0.946 (0.850-1.053)	0.307
Grade-2 obesity	3.89 (3.41-4.45)	0.939 (0.802-1.100)	0.435
Arterial hypertension
No	4.04 (3.85-4.24)	1.00	—
Yes	4.16 (3.94-4.39)	1.029 (0.957-1.106)	0.434
Diabetes mellitus
No	4.05 (3.90-4.22)	1.00
Yes	4.29 (3.93-4.69)	1.059 (0.961-1.167)	0.246
Behavioral disorders
No	4.08 (3.92-4.24)	1.00	-
Yes	4.19 (3.80-4.63)	1.029 (0.926-1.144)	0.597
Smoking
No	4.10 (3.95-4.26)	1.00
Yes	4.11 (3.38-5.00)	1.002 (0.822-1.222)	0.982
Previous cancer diagnosis
No	4.09 (3.94-4.25)	1.00
Yes	4.13 (3.60-4.75)	1.01 1 (0.875-1.167)	0.88 3
Heart disease
No	4.06 (3.91-4.22)	1.00	—
Yes	4.38 (3.94-4.88)	1.080 (0.964-1.209)	0.185
Grade on the ASA classification
I	3.96 (3.50-4.48)	1.00	-
II	4.01 (3.85-4.17)	1.013 (0.890-1.152)	0.849
III	5.14 (4.49-5.88)	1.297 (1.083-1.554)	0.005
Operative time (hours)		1.045 (0.992-1.102)	0.098
Postoperative complications
No	3.90 (3.76-4.04)	1.00	—
Yes	5.86 (5.21-6.60)	1.505 (1.332-1.700)	< 0.001

	Proportion of patients with postoperative complications# (95%CI)	Odds ratio (95%CI)	p-value
Gender
Female	7.2% (4.9%-10.5%)	0.688 (0.360-1.313)	0.256
Male	10.1% (6.4%-15.6%)	1.00
Age	—	1.000 (0.965-1.036)	0.998
Age by subgroup
< 59 years	11.4% (5.2%-23.2%)	1.00	—
60 to 69 years	5.9% (3.2%-10.7%)	0.486 (0.167-1.413)	0.185
70 to 79 years	8.1% (5.2%-12.5%)	0.684 (0.258-1.813)	0.444
> 80 years	11.7% (6.0%-21.7%)	1.026 (0.334-3.153)	0.965
BMI (kg/m²)		0.992 (0.925-1.064)	0.830
BMI by subgroup
Low weight/Normal weight	9.0 (4.6%-16.9%)	1.00	-
Overweight	8.8% (5.6%-13.6%)	0.975 (0.410-2.316)	0.954
Grade-1 obesity	5.7% (3.0%-10.7%)	0.609 (0.226-1.638)	0.325
Grade-2 obesity	11.0% (4.2%-25.7%)	1.239 (0.352-4.354)	0.738
Arterial hypertension
No	7.7% (5.1 .4%)	1.00	-
Yes	8.7% (5.7%-13.1%)	1.146 (0.606-2.167)	0.674
Diabetes mellitus
No	7.6% (5.5%-10.6%)	1.00	-
Yes	10.7% (5.7%-19.3%)	1.459 (0.672-3.170)	0.339
Behavioral disorders
No	7.9% (5.8%-10.9%)	1.00	-
Yes	9.3% (4.3%-18.9%)	1.183 (0.482-2.899)	0.714
Smoking
No	8.2% (6.1 .0%)	1.00	-
Yes	6.7% (1.1 %-32.6%)	0.803 (0.116-5.557)	0.824
Previous cancer diagnosis
No	8.2% (6.1 %-11.1%)	1.00
Yes	6.7% (1.8%-21.6%)	0.800 (0.200-3.205)	0.752
Heart Disease
No	8.0% (5.8%-10.9%)	1.00	-
yes	9.2% (4.0%-20.1%)	1.174 (0.446-3.091)	0.745
Grade on the ASA classification
I	8.2% (2.7%-21.9%)	1.00	-
II	7.3% (5.1 %-10.1 %)	0.879 (0.263-2.936)	0.834
III	20.6% (10.1%-37.4%)	2.920 (0.707-12.068)	0.138
Operative time	—	1.517 (0.987-2.331)	0.057

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[1] Address for correspondence Filipe Marques de Oliveira, MD, Avenida Albert Einstein 627/701, 3° andar, Edifício A1, sala 303, 05652-000, São Paulo-SP, Brazil (e-mail: filipe.deoliveira@einstein.br).