Use of independent toileting to predict length of stay in patients with knee and hip joint arthroplasty

Abstract

Introduction: The aim of this article is to determine if independent toileting (Toilet Days) could be used as a functional discharge indicator in patients with total knee arthroplasty (TKA) and total hip arthroplasty (THA). Independent toileting after surgery, which requires the ability to manage the lower garment, transfer, ambulation, judgement and safety awareness, has been used as hospital discharge criteria. Methods: All records with total joint arthroplasty done in 2019 at Queen Mary Hospital were analysed. The Toilet Days, age, gender, social support, and type of operations were included in multiple regression to identify the predictors for postoperative length of stay (LOS) in an acute hospital. Results: A total of 305 cases (198 female, 107 male) were captured, mean age 68 ± 11.4 years (range, 17-97 years). Of them, 70% received TKA and the other 30% received THA. The average Toilet Days was 3.2 ± 2.7 days (TKA: 2.8 ± 2.9 days; THA: 3.9 ± 2.1 days). Multiple regression shows that Toilet Days was the only statistically significant predicting factor in LOS (p<0.001, R2 =0.27), with positive correlation (r=0.52, p<0.0001). Conclusion: Independent toileting could be used as a functional discharge indicator. Patients who can manage independent toileting are more confident to return home. Activity of daily living training after surgery, especially in toilet use, is essential in promoting early and safe discharge home.