What factors predict extended length of stay and which ones predict early postop complications following unicompartmental arthroplasty (UKA) surgery?
Want to Cut Length of Stay? Try Robotics and Healthier Patients
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A group of researchers from Charing Cross Hospital in London set out to get some answers.
Their work, “Predictors of extended length of stay after unicompartmental knee arthroplasty,” was published in the September 17, 2019 edition of the Journal of Clinical Orthopaedics and Trauma.
Co-author Dinesh Nathwani, MBChB, MSc, FRCS, consulting orthopedic surgeon and head of specialty for the Trauma & Orthopaedic Service at Imperial College Healthcare, Charing Cross & St Mary’s Hospital explained the purpose of this new study to OTW, “In order to establish LOS [length of stay] predictors in UKA patients at our institution, we conducted a retrospective analysis all patients undergoing primary UKA from January 2016 – January 2019.”
The research team collected information from 155 patients who’d been treated with primary unicompartmental arthroplasty using a variety of techniques ranging from conventional jig-based techniques, patient specific cutting guides and robotic surgery using the Navio platform.
Dr. Nathwani summarized the results of the study to OTW. “We performed multivariate regression analysis that showed American Society of Anesthesiologists (ASA) grade 3-4 patients and those with a history of cardiovascular disease were significant predictors of prolonged hospital stay.”
“Alongside this we also looked at predictive factors for complications in our UKA population. Again, using multivariate regression analysis, we found that ASA grade 3-4 and high body mass index (BMI) were significant predictors of increased complication rates in our population.”
“The study also showed a statistically significant improved length of stay in robotically performed unicompartmental knees using the Navio system when compared with other modalities of implantation.”
“In recent years, reduction in the length of stay in patients undergoing UKA has gained considerable interest. This has led to the introduction of ‘fast track’, ‘enhanced recovery’ and outpatient surgery pathways aimed at reducing cost and improving the safety of UKA. A natural progression was to develop a day-case surgery pathway for UKAs.”
“Several authors to date have reported on the feasibility and safety of UKA as a day-case procedure. When considering implementation of day-case procedures in the United Kingdom or elsewhere, patient selection is likely to play a crucial role. This study concludes that selection of patients for day-case protocols with low ASA grades (1-2), an absence of cardiovascular disease and low BMI may improve the success of implemented pathways.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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