TY - JOUR
T1 - The effect of disease severity and comorbidity on length of stay for orthopedic surgery in rheumatoid arthritis
T2 - Results from 2 UK inception cohorts, 1986-2012
AU - Nikiphorou, Elena
AU - Morris, Stephen
AU - Dixey, Josh
AU - Williams, Peter L.
AU - Kiely, Patrick
AU - Walsh, David A.
AU - MacGregor, Alex
AU - Young, Adam
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Objective. To examine factors predicting length of stay (LoS) for orthopedic intervention in rheumatoid arthritis (RA). Methods. LoS for orthopedic intervention was examined in 2 consecutive, multicenter inception cohorts: the Early RA Study (n = 1465, 9 centers) and the Early RA Network (n = 1236, 23 centers). Date, type of orthopedic procedure, and LoS were recorded and validated against national data, the UK National Joint Registry, and the UK Hospital Episode Statistics database. Clinical, laboratory, and radiographic measures and comorbidity recorded at baseline and annually were examined for their predictive power on LoS using regression analysis. Results.A total of 770 of 2701 patients (28.5%) had 1602 orthopedic interventions: 40% major (mainly total hip/knee replacements), 24% intermediate (mainly hand/wrist and ankle/foot surgery), and 16% minor (mainly soft tissue surgery). Median (interquartile range) LoS was 8 (5-13), 3 (1-5), and 1 (0-2) days for major, intermediate, and minor interventions, respectively. Older age predicted longer LoS (p < 0.001) whereas a more recent operation year predicted shorter LoS (p < 0.001). Markers of active disease, namely low hemoglobin, high Health Assessment Questionnaire, and high Disease Activity Scores in the first year all predicted longer LoS for all types of surgery (p = 0.001, p < 0.001, p = 0.05, respectively). Presence of 1 or more major comorbidities predicted longer LoS (p < 0.001). Conclusion. Comorbidity and standard clinical and laboratory markers of disease activity affect the LoS for orthopedic surgery in RA, which has important clinical and economic implications, providing a target for improving patient outcomes.
AB - Objective. To examine factors predicting length of stay (LoS) for orthopedic intervention in rheumatoid arthritis (RA). Methods. LoS for orthopedic intervention was examined in 2 consecutive, multicenter inception cohorts: the Early RA Study (n = 1465, 9 centers) and the Early RA Network (n = 1236, 23 centers). Date, type of orthopedic procedure, and LoS were recorded and validated against national data, the UK National Joint Registry, and the UK Hospital Episode Statistics database. Clinical, laboratory, and radiographic measures and comorbidity recorded at baseline and annually were examined for their predictive power on LoS using regression analysis. Results.A total of 770 of 2701 patients (28.5%) had 1602 orthopedic interventions: 40% major (mainly total hip/knee replacements), 24% intermediate (mainly hand/wrist and ankle/foot surgery), and 16% minor (mainly soft tissue surgery). Median (interquartile range) LoS was 8 (5-13), 3 (1-5), and 1 (0-2) days for major, intermediate, and minor interventions, respectively. Older age predicted longer LoS (p < 0.001) whereas a more recent operation year predicted shorter LoS (p < 0.001). Markers of active disease, namely low hemoglobin, high Health Assessment Questionnaire, and high Disease Activity Scores in the first year all predicted longer LoS for all types of surgery (p = 0.001, p < 0.001, p = 0.05, respectively). Presence of 1 or more major comorbidities predicted longer LoS (p < 0.001). Conclusion. Comorbidity and standard clinical and laboratory markers of disease activity affect the LoS for orthopedic surgery in RA, which has important clinical and economic implications, providing a target for improving patient outcomes.
KW - Disease markers
KW - Hemoglobin
KW - Length of stay
KW - Orthopedic surgery
KW - Rheumatoid arthritis
KW - Total joint replacement
UR - http://www.scopus.com/inward/record.url?scp=84940565970&partnerID=8YFLogxK
U2 - 10.3899/jrheum.141049
DO - 10.3899/jrheum.141049
M3 - Article
C2 - 25834200
AN - SCOPUS:84940565970
SN - 0315-162X
VL - 42
SP - 778
EP - 785
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 5
ER -