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Title: Can we predict length of stay in orthopaedic rehabilitation?
Authors: Thanarajah, Premini
Hale, Thomas
McKenzie, Dean
Olver, John
Keywords: Joint Replacements
Neck of Femur
Rates of Fractures
Pain at Rest
Pain on Movement
Hip Replacement
Knee Replacement
Functional Idependence Measure
Length of Stay
Least Absolute Shrinkage and Selection Operator
Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth Monash Rehabilitation Unit (EMReM), Epworth HealthCare, Richmond, Victoria, Australia.
Issue Date: 2018
Publisher: Bio Accent
Citation: BAOJ Ortho. 2018; 3(1): 019
Abstract: OBJECTIVES: Rates of Joint Replacements and Neck of Femur (NOF) fractures are rapidly increasing due to an ageing population, thus placing an increasing demand on Rehabilitation Services. METHOD: We conducted this retrospective study to investigate how pain at rest and on movement (documented on admission), type of operation (hip/ knee replacement vs neck of femur fracture), age, gender and admission Functional Independence Measure (FIM) total score impacted on Length of Stay (LOS). The cohort comprised all consecutive patients admitted to a Victorian Rehabilitation Hospital post Fractured NOF, Elective Total Hip and Total Knee Replacement surgery from 6 February 2012 – 6 June 2012. The sample comprised 63 patients, predominantly female (54 or 85.7%), aged from 48-96 years (mean=74, sd=11.1). LOS ranged from 2-49 days (mean=17.2, sd=9.5). Multiple regression examined all 6 variables simultaneously. A contemporary variable selection method, known as LASSO regression, searched for key variables by attempting to shrink less important regression coefficients towards zero. The main outcome measure in this study length of stay. No interventions were used in this study. RESULTS: The full regression model of 6 variables accounted for 65.3% variation in LOS, however, LASSO regression selected 3 variables which accounted for 62.9% of variation in LOS, there being no statistically significant loss of performance with the smaller model. The 3 variables were admission FIM, operation type, and pain on movement. Increased admission FIM and knee or hip replacement were associated with shorter LOS, Neck of Femur fracture and increased pain on movement were associated with longer LOS. CONCLUSION: Given the increased demand on rehabilitation beds, predicting length of stay using the 3 key markers identified in this study may help to optimise resource allocation.
Journal Title: BAOJ Orthopedics
Type: Journal Article
Affiliated Organisations: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria
Type of Clinical Study or Trial: Retrospective studies
Appears in Collections:Rehabilitation

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