Even though the organizational structure at our center is strong enough to provide for an adequate weekend workforce to discharge these patients, this study had a few limitations. We could not study readmission rates and whether the transition to home health and home physical therapy for the patients who went home was seamless.
We found that only 3 patient characteristics had a significant effect on LHS: higher ASA grade (a surrogate for medical comorbidities), requirement for blood transfusion, and presence of complications. In Denmark, blood transfusion increased the likelihood of longer LHS by 400%.4 In that study, patients who were ASA grades 1 and 2 had 60% and 20% decreased likelihood of LHS of more than 3 days compared with patients who were ASA grade 3. Similarly, in 2009, Mears and colleagues5 found 4 factors related to increased LHS: female sex (P < .001), older age (P < .001), higher ASA grade (3, P < .01; 4, P < .001), and increased blood loss (P < .001).5
Conclusion
Over the past decade, there has been a significant reduction in LHS after THA, from a mean of 3 weeks to 4 days. Advances in implant technology, delivery of in-home physical therapy, and improved prevention and management of postoperative complications have contributed to this decline. Early identification of patients with transfusion requirements may be helpful in expediting their care. Although guidelines are in place for transfusion, further study in this regard may be needed. It is important to continue to identify surgery and patient factors that affect LHS, but the importance of organizational and planning issues in optimizing hospital health care expenditures cannot be ignored. Further study of providing a specific discharge planning service to identify patients’ discharge needs (home vs extended care facility) may help reduce LHS.