The effect of disease severity and comorbidity on length of stay for orthopedic surgery in rheumatoid arthritis: Results from 2 UK inception cohorts, 1986-2012

Elena Nikiphorou, Stephen Morris, Josh Dixey, Peter L. Williams, Patrick Kiely, David A. Walsh, Alex MacGregor, Adam Young

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)778-785
Number of pages8
JournalJournal of Rheumatology
Volume42
Issue number5
DOIs
Publication statusPublished - 1 May 2015

Keywords

  • Disease markers
  • Hemoglobin
  • Length of stay
  • Orthopedic surgery
  • Rheumatoid arthritis
  • Total joint replacement

Fingerprint

Dive into the research topics of 'The effect of disease severity and comorbidity on length of stay for orthopedic surgery in rheumatoid arthritis: Results from 2 UK inception cohorts, 1986-2012'. Together they form a unique fingerprint.

Cite this