Does the Timing of Pre-Operative Medical Evaluation Influence Perioperative Total Hip Arthroplasty Outcomes?

Roy H. Lan1, Atul F. Kamath2, *
1 College of Arts and Sciences, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
2 Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

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Creative Commons License
© 2017 Lan and Kamath

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Penn Medicine, Department of Orthopedic Surgery, Pennsylvania Hospital, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107, USA; Tel: 215-687-8169; Fax: 215-829-2492; E-mail:

Study approved by the institutional review board



Medical evaluation pre-operatively is an important component of risk stratification and potential risk optimization. However, the effect of timing prior to surgical intervention is not well-understood. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes.


We retrospectively reviewed 167 elective THA patients to study the relationship between the number of days between pre-operative evaluation (range, 0-80 days) and surgical intervention. Patients’ demographics, length of stay (LOS), ICU admission frequency, and rate of major complications were recorded.


When pre-operative evaluation carried out 4 days or less before the procedure date, there was a significant reduction in LOS (3.91 vs. 4.49; p=0.03). When pre-operative evaluation carried out 11 days or less prior to the procedure date, there was a four-fold decrease in rate of intensive care admission (p=0.04). Furthermore, the major complication rate also significantly reduced (p<0.05). However, when pre-operative evaluation took place 30 days or less before the procedure date compared to more than 30 days prior, there were no significant changes in the outcomes.


From this study, pre-operative medical evaluation closer to the procedure date was correlated with improved selected peri-operative outcomes. However, further study on larger patient groups must be done to confirm this finding. More study is needed to define the effect on rare events like infection, and to analyze the subsets of THA patients with modifiable risk factors that may be time-dependent and need further time to optimization.

Keywords: ICU admission frequency, Total hip arthroplasty, Length of stay in hospital, Major complications, Pre-operative evaluation, Total joint arthroplasty.