Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
NG HL (1), POON LY(1), LAU WL(1), CHUI TC (1), Chin YM (1)
Affiliation :
(1) Occupational Therapy Department, Pamela Youde Nethersole Eastern Hospital
Introduction :
The demand for total knee replacement (TKR) places a heavy economic burden on the healthcare system in Hong Kong . While shortening length of hospital stay (LOS) reduces the associated cost, the association between preoperative patient-related sociodemographic factors and prolonged LOS remains unknown.
Objectives :
To identify preoperative patient-related sociodemographic predictors of LOS following primary TKR performed at Pamela Youde Nethersole Eastern Hospital (PYNEH).
Methodology :
We retrospectively reviewed primary TKR performed at PYNEH from July 2021 to October 2023. Preoperative patient-related sociodemographic factors that might influence LOS were recorded.
Result & Outcome :
A total of 484 patients were identified. The mean LOS was 8.09 days (SD= 4.16). Spearman’s correlation coefficient was calculated between variables with LOS. Age (r=0.217, p< 0.001), Depression Anxiety Stress Scale (DASS)-Depression (r=0.123, p=0.007) and DASS-Anxiety (r=0.109, p=0.016) were found significantly positively correlated with LOS. Accessibility of direct lift landing flat (r=-0.093, p=0.041), availability of caregivers (r=-0.117, p=0.010), provision of preoperative home visit by occupational therapists (r=-0.100, p=0.028) and premorbid Modified Barthel Index (r=-0.166,p < 0.001) were found significantly negatively correlated with LOS.
The factors with a p value < 0.05 in the univariate analysis were further analyzed in a multivariate model. The multiple R (0.317) was shown to be statistically significant (F=7.615, p< 0.001). Predictors of prolonged LOS following primary TKR were advanced age (p< 0.001), absence of caregivers (p=0.002), absence of preoperative home visits by occupational therapists (p=0.049), higher dependence in premorbid activities of daily living (p< 0.001) and higher DASS-Depression score (p=0.043).
Conclusion:
While occupational therapists provide holistic assessments and treatments for individuals’ functional performance, psychological and environmental aspects, evaluating patient-related sociodemographic factors that can predict LOS facilitates preoperative assessments. Identification of high-risk patients who will require a longer hospitalization enables proactive discharge planning with a multidisciplinary approach. Preoperative home visits by occupational therapists have been associated with shorter LOS, but no causal relationship can be identified and further experimental studies are warranted.
