ArticleBMJ open2018
Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
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Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Surgery for early structural osteoarthritis of the hip and knee: the SCORE evidence synthesis and economic evaluation.Health technology assessment (Winchester, England) · 2026Pooled it
- Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis.Archives of orthopaedic and trauma surgery · 2022Pooled it
- Enzyme-linked immunosorbent assays for monitoring TNF-alpha inhibitors and antibody levels in people with rheumatoid arthritis: a systematic review and economic evaluation.Health technology assessment (Winchester, England) · 2021Pooled it
- Pooled it
- Outcomes of reverse shoulder arthroplasty as a day case procedure: a population-based cohort study using the National Joint Registry and Hospital Episode Statistics.Annals of the Royal College of Surgeons of England · 2026Article
- Identifying patients at risk in revision arthroplasty: a comprehensive single-centre analysis.Journal of orthopaedic surgery and research · 2026Article
- Article
- Trends in hip and knee replacement length of stay and patient demographics in England: a population-based study of 1,455,842 primary procedures.BMC medicine · 2025Article
- Development and validation of a nomogram prediction model for perioperative deep vein thrombosis risk in arthroplasty: a retrospective study.Frontiers in medicine · 2025Article
- Length of postoperative stay prediction in elderly patients with hip fractures based on machine learning.Frontiers in medicine · 2025Article
- Does interaction occur between risk factors for revision total knee arthroplasty?Archives of orthopaedic and trauma surgery · 2024Article
- Predicting 30-Day Venous Thromboembolism Following Total Joint Arthroplasty: Adjusting for Trends in Annual Length of Stay.Arthroplasty today · 2024Article
- Comprehensive Pain Management in Total Joint Arthroplasty: A Review of Contemporary Approaches.Journal of clinical medicine · 2024Review
- Determinants of Length of Stay for Medical Inpatients Using Survival Analysis.International journal of environmental research and public health · 2024Article
- Predicting extended hospital stay following revision total hip arthroplasty: a machine learning model analysis based on the ACS-NSQIP database.Archives of orthopaedic and trauma surgery · 2024Article
- Predicting hospital length of stay using machine learning on a large open health dataset.BMC health services research · 2024Article
- Variation in processes of care for total hip arthroplasty across high-income countries.Health affairs scholar · 2024Article
- Association between Obesity and Short-Term Patient-Reported Outcomes following Total Knee Arthroplasty: A Retrospective Cohort Study in Japan.Journal of clinical medicine · 2024Article
- Total hip arthroplasty for adult patients with hip arthritis in Jordan: clinical profiles and patient characteristics.International orthopaedics · 2024Article
- Artificial intelligence in planned orthopaedic care.SICOT-J · 2024Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
objectivesTo measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles.
designCross-sectional study using routinely collected data.
settingNational Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care.
participantsStudy participants had a diagnosis of osteoarthritis or rheumatoid arthritis.
interventionsPrimary TKR, primary THR, revision TKR and revision THR. PRIMARY OUTCOME MEASURES: Length of stay and hospital reimbursement.
results10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included.
conclusionsLength of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.
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