Body Mass Index, Sex, and Age Are Predictors of Discharge to a Post-acute Care Facility Following Total Ankle Arthroplasty.

Yianni Bakaes, Tyler A. Gonzalez, James W Hardin, J Benjamin Jackson
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Abstract

BACKGROUND The utilization of total ankle arthroplasty (TAA) continues to increase. Discharge to a post-acute care (PAC) facility can increase patient morbidity and postoperative costs. The purpose of this study is to investigate the effects of age and body mass index (BMI) on discharge to a PAC facility and hospital length of stay (LOS) following TAA. METHODS A retrospective review of patients who underwent TAA from the National Surgical Quality Improvement Program (NSQIP) database was performed. Using overweight patients as the reference BMI group, sex- and age-adjusted log-binomial regression models were utilized to estimate risk ratios of BMI categories for being discharged to a PAC facility. A linear regression was utilized to estimate the effect of BMI category on hospital LOS. RESULTS Obese patients had 1.36 times the risk of overweight patients (P = .040), and morbidly obese patients had 2 times risk of overweight patients (P = .001) of being discharged to a PAC facility after TAA. Men had 0.48 times the risk of women (P < .001). Compared with patients aged 18 to 44 years, patients aged ≥65 years had 4.13 times the risk (P = .012) of being discharged to a PAC facility after TAA. Relative to overweight patients, on average there was no difference in hospital LOS for underweight patients, but healthy weight patients stayed an additional 0.30 days (P=.003), obese patients stayed an additional 0.18 days (P = .011), and morbidly obese patients stayed an additional 0.33 days (P = .009). Men stayed 0.29 fewer hospital days than women (P < .001) on average. CONCLUSION Women and patients who are obese or morbidly obese have a longer hospital LOS and an increased chance of being discharged to a PAC facility. Increasing age is also associated with an increased risk of being discharged to a PAC. These may be important factors when developing and discussing the postoperative plan with patients prior to TAA. LEVELS OF EVIDENCE Level III.
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体重指数、性别和年龄是全踝关节置换术后出院到后期护理机构的预测因素。
背景全踝关节置换术(TAA)的使用率持续上升。出院后转入急性期后护理(PAC)机构会增加患者的发病率和术后费用。本研究的目的是调查年龄和体重指数(BMI)对TAA术后出院到PAC机构和住院时间(LOS)的影响。方法对国家外科质量改进计划(NSQIP)数据库中接受TAA手术的患者进行回顾性研究。将超重患者作为参考体重指数组,利用性别和年龄调整后的对数二项式回归模型来估计体重指数类别与出院到 PAC 机构的风险比。结果肥胖患者在 TAA 后出院到 PAC 机构的风险是超重患者的 1.36 倍(P = .040),病态肥胖患者的风险是超重患者的 2 倍(P = .001)。男性的风险是女性的 0.48 倍(P < .001)。与 18-44 岁的患者相比,年龄≥65 岁的患者在 TAA 后出院到 PAC 机构的风险是后者的 4.13 倍(P = .012)。与超重患者相比,体重不足患者的平均住院时间没有差异,但健康体重患者的住院时间增加了0.30天(P=.003),肥胖患者增加了0.18天(P=.011),病态肥胖患者增加了0.33天(P=.009)。结论肥胖或病态肥胖的女性和患者的住院时间更长,出院到 PAC 机构的几率也更大。年龄的增加也与出院到 PAC 的风险增加有关。这些可能是在 TAA 术前与患者制定和讨论术后计划时的重要因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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