OBJECTIVES: As demand for TKA in Australia has seen steady growth over the past decade, there is increasing interest in optimizing the post-acute care to reduce hospitalization duration and overall financial burden. Post-operative recovery is influenced by many factors, such as management protocols, patient characteristics or implant design. This study aims to describe the real-world hospital LOS, discharge status and DR of TKA patients at an acute hospital and assess factors that influence them.

METHODS: A retrospective review of adult TKA patients at Mater Miscericordiae hospital between January 2013 and December 2017. Baseline demographic, clinical events and implant information were captured. Data is summarised using descriptive statistics. Generalised Linear Models were used to assess the influence of implant and patient demographics on study endpoints.

RESULTS: Results from 173 patients (mean age 70.4 years; 63.6% female; 59% obese, 94.2% ASA II-III) showed a mean LOS of 5.3 (95% CI 5.0-5.6). 67.1% of the patients were discharged home without home care support. Mean days to achieve DR was 4.1 (95% CI 3.8 - 5.6). Study endpoints were observed to be influenced by gender, obesity, ASA and implant design. Patients with Attune implants (N=68) were associated with statistically significant reduction in: a) adjusted mean LOS (p<0.05), b) proportion of patients discharged home without home care support (p<0.01) and c) days to achieve DR (p<0.01) when compared to PFC Sigma (N=105). All patients achieved DR before actual discharge. Only 22% of patients were discharged on the same day they achieved DR.

CONCLUSIONS: Patient characteristics and implant design influenced LOS, discharge destination and DR. While the mean LOS was within the national reported average, patients could achieve DR on average 1.5 days earlier. Better alignment between DR and actual discharge can have a significantly positive impact on healthcare economics by directly reducing episode of care costs.