Abstract
Early mobilization within the first 12 hours (day zero) of total joint arthroplasty (TJA) has been shown to reduce length of stay (LoS) without risking clinical outcomes, patient safety or satisfaction. The purpose of this study was to investigate associations between the degree of mobilization on day zero (i.e., standing at the bedside versus walking in the hallway) and LoS in TJA patients. In addition, we investigated predictors of LoS and day zero mobilization.
A retrospective cohort study was undertaken of the health records of patients in a community hospital setting who had an elective unilateral primary TJA between June 2015 and May 2017 and had mobilized on day zero.
The total sample was 283 patients (184 TKA and 99 THA) across four mobilization categories: Sat on beside (n = 76), Stood by bed/marched in place (n = 83), Walked in the room (n = 79), and Walked in hall (n = 45). Analysis of variance found no significant group differences in age, ASA score, Charlson Comorbidity Index score, anesthesia, surgeon, procedure type, pain medication, and patient reported symptoms recorded by physiotherapists. Significantly more women were in the Sat group and significantly more men were in the Hall group (p < .001). Patient reported symptoms of nausea and drowsiness were significantly greater for the Sat group (p < .001). LoS was also significantly different across the groups. Post hoc Tukey comparisons found the Walked Hall group had significantly shorter LoS (M = 2.7 days) than the Sat group (M = 3.9, p < .001), Stood group (M = 3.4, p = .011), and the Walked Room group (M = 3.5, p = .004).
A hierarchical regression was performed to determine predictors of LoS. Block 1 consisted of demographic, medical status, and patient reported symptoms as variables. Mobilization was entered in Block 2. The first model was significant (p < .001) and explained 24% of variance in LoS. The final model was also significant (p < .001), accounting for a total of 26% of the variance in LoS. Thus, block 2 (i.e., mobilization) accounted for a small but significant 2% incremental variance (p = .008) beyond the block 1 variables in the prediction of LoS. With mobilization added, only male gender (p = .002), lower BMI (p = .026), and lower ASA scores (p = .006) remained significant predictors of shorter LoS, and the predictive ability of several of the block 1 variables were reduced to non-significant levels. A simultaneous regression model was then used to predict degree of mobilization. The model accounted for 24% of the variance in mobilization (p < .001). Variables significantly associated with a greater degree of mobilization included: younger age, male gender, lower BMI, and fewer symptoms, namely nausea, numbness, lightheadedness, and drowsiness.
This study found length of stay was shorter when patients mobilized farther on the day of surgery. Some factors predictive of mobilization may be modifiable. Focusing on symptom management could increase opportunities for farther mobilization on the day of surgery, and thus decrease length of stay.
