Length of stay following primary total hip replacement

INTRODUCTION Much of the cost of primary total hip arthroplasty (THA) comprises the length of stay in hospital. Given the increasing drive for cost-effective surgery in today's National Health Service, the aim of this investigation was to determine the patient and surgical factors that most influence the length of stay following surgery. PATIENTS AND METHODS A large, population-based study of 675 consecutive patients in a regional orthopaedic centre in the South West of Britain. RESULTS The median length of stay was 8 days. The majority of patients (81.5%) left hospital within 2 weeks, 13.6% within 2-4 weeks and 4.9% after 4 weeks. On multivariate analysis, age above 70 years, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks. CONCLUSIONS Prolonged stay after THA is largely predetermined by case mix and this should be taken into account when units are compared for performance and in the remuneration they receive for providing this service. Slick surgery through limited incisions may reduce the length of stay.