Authors: James Feng, Afshin Anoushiravani, William J Hozack1, Edward M Adler, Jonathan M Vigdorchik, Ran Schwarzkopf2, Javad Parvizi3, William B Macaulay4
1The Rothman Institute, 2NYU Langone MC Hospital For Joint Diseases, 3Rothman Institute, 4NYU Langone Medical Center
Abstract
Introduction
A better understanding of patient expectations within the perioperative setting will enable clinicians to tailor care to the needs of the total knee arthroplasty (TKA) candidate. Such an approach will promote patient centered decision-making; optimize recovery times, while enhancing hospital quality metrics mandated by the Centers for Medicaid and Medicare Services (CMS). In the current study, we pre- and post-operatively surveyed total knee arthroplasty (TKA) candidates to elucidate the relationship between patient expectations and length of stay.
Methods
This is a multicenter prospective study among TKAs candidates between December 2017 and April 2018. Using a novel electronic patient rehabilitation application (EPRA), patients were administered surveys regarding their discharge planning 1 week pre- and post-operatively (Table 1). Using each institution’s electronic data warehouse, baseline demographics, surgical factors and hospital reported length of stay (LOS) were queried. Patients were grouped by their hospital reported LOS. All statistical analyses were performed using MatLab 2018a. ANOVA tests were used for continuous variables, χ2 for nominal variables and Wilcoxon rank sum tests for ordinal variables. A linear regression was to correlate preoperativ discharge discussions with patient discharge plan acceptance (comfort) levels. A p value of <0.05 was deemed significant.
Results
In total, 65 TKAs were performed by 6 surgeons at 2 high volume orthopaedic hospitals (Table 2). Patients with significantly shorter LOS were male gender (p<0.05), lower BMIs (0.01, and had commercial insurance (p<0.05). Medical literacy regarding inpatient LOS was assessed by the accuracy of patient perceived LOS when surveyed postoperatively (Table 3). This was found to be 98.46% (64/65 patients). Preoperative discussions regarding LOS occurred in 86.15% (56/65) of patients with no significant differences among the cohorts (Table 3). Shorter LOS patients demonstrated significantly higher levels of preoperative discharge duration acceptance (“Very Comfortable” rate in: SDD [Same Day Discharge] – 100.00%; NDD – 57.14%; 2 days – 40.91%; 3+ days – 23.08%; p<0.05) and were more interested in participating in SDD programs (“Very Likely” or “Likely” rate in SDD – 100.00%; NDD – 46.43%; 2 days – 27.28%; 3+ days – 7.69%; p<0.001). Linear regression modeling demonstrated discussions of inpatient LOS significantly correlated with improved patient discharge duration acceptance preoperatively (p<0.01; Figure 1). Postoperatively, shorter LOS patients did not significantly correlate with patient discharge acceptance (p=0.33) or patient LOS satisfaction.
Discussion and Conclusion
Our results suggest that managing patient expectations is an essential component in successful and timely discharge after TKA. Having clear discussions regarding discharge, can improve a patient’s postoperative course. Inpatient LOS does not appear to significantly affect discharge satisfaction.