Preoperative factors associated with extended postoperative length of stay in patients undergoing primary hip arthroplasty.

Abstract

Orthopaedic disorders of the hip are becoming more common in many countries around the world, including South Africa. Conservative medical treatment of severe hip disorders might sometimes be ineffective in reducing pain or restoring hip function in some patients. In these patients, surgical intervention, through primary hip arthroplasty, remains the only viable option for reducing pain and restoring hip function. The increasing demand for primary hip arthroplasty in South Africa poses a problem for many resource-limited orthopaedic units in the country. It is possible that many of these orthopaedic units will be forced to consider fast-track surgery and recovery protocols to cope with the increased demand for primary hip arthroplasty. These protocols aim to shorten postoperative LoS, reduce complications, and allow for more efficient financial expenditure and resource allocation per patient. An understanding of which characteristics are associated with extended postoperative length of stay (EPLoS) in primary hip arthroplasty patients would have important implications for fast-track postoperative protocols being implemented in South African settings. This was the impetus for the current study. This study was a retrospective chart review involving 185 South African primary hip arthroplasty patients. Univariate and multivariate data analysis were performed to identify crude and independent associations between various characteristics and EPLoS. There were three preoperative risk factors (gender, fixed flexion deformity, patient’s maximum walking distance) and one intraoperative risk factor (extended duration of surgery) which were independently associated with EPLoS following primary hip arthroplasty in South African patients.