BJA finds PCS >20 predicts LOS

1/ A new BJA Open study suggests a simple pre-op questionnaire may help flag which hip and knee replacement patients are less likely to leave hospital quickly. In a prospective multicentre cohort from Denmark, patients with a preoperative Pain Catastrophising Scale, or PCS, score above 20 had higher odds of staying more than two days, being readmitted within 90 days, and failing planned same-day discharge. (pubmed.ncbi.nlm.nih.gov) 2/ The study covered 15,965 procedures performed from September 2022 to June 2025 across eight Danish arthroplasty departments using similar fast-track protocols. The operations included total hip arthroplasty, total knee arthroplasty and unicompartmental knee arthroplasty. (pubmed.ncbi.nlm.nih.gov) 3/ PCS is a 13-item self-reported measure of pain-related rumination, magnification and helplessness, scored from 0 to 52. In this study, 5,225 patients — about 33% of the cohort — had PCS scores above 20 before surgery. 4/ The headline result: PCS >20 was associated with a higher chance of length of stay above two days. (pubmed.ncbi.nlm.nih.gov) The adjusted odds ratio was 1.54, according to the study abstract indexed by PubMed. 5/ Readmissions also moved in the same direction. A PCS score above 20 was associated with higher 90-day all-cause readmission, with an adjusted odds ratio of 1.18, and with pain- or mobilisation-related prolonged stay/readmission, with an adjusted odds ratio of 1.38. (pubmed.ncbi.nlm.nih.gov) 6/ Same-day pathways were not immune. Among patients scheduled for same-day surgery, PCS >20 was associated with a higher likelihood of postoperative admission rather than discharge the same day, with an adjusted odds ratio of 1.25. (ebiotrade.com) 7/ One useful detail is that this was not a study of a loose or immature pathway. (pubmed.ncbi.nlm.nih.gov) The cohort came from fast-track centres, and the paper specifically asked whether catastrophising still mattered even when discharge systems were already optimized. The answer was yes. 8/ The authors were led by Christoffer C. (ebiotrade.com) Jørgensen, with co-authors including Simon Kornvig and Henrik Kehlet, and were affiliated with the Centre for Fast-track Hip and Knee Replacement and Danish university hospitals. 9/ Why does that matter operationally? Because most same-day arthroplasty selection tools lean heavily on medical comorbidity, frailty, home support and logistics. (ebiotrade.com) This paper argues that a psychological pain-risk signal adds independent information about who may struggle with discharge and early recovery. That is an inference from the reported adjusted models. (pubmed.ncbi.nlm.nih.gov) 10/ The paper does not say PCS should be used to deny surgery. It points instead toward targeted prehabilitation, pain-preventive planning and tighter day-case triage for patients scoring above 20. BJA Open summarized the finding as evidence that patients with PCS >20 “may benefit the most” from targeted interventions. (pubmed.ncbi.nlm.nih.gov) 11/ There are limits. This was an observational cohort, not a randomized trial, so it shows association rather than proof that lowering PCS will shorten stay or cut readmissions. Some procedure-specific analyses were not statistically significant, including the link with LOS >2 days after unicompartmental knee arthroplasty and 90-day readmission after total knee arthroplasty. (pubmed.ncbi.nlm.nih.gov) 12/ Still, for arthroplasty programs trying to expand day-case volume without driving up failed discharge or readmission, the study gives a concrete threshold to test in practice: PCS >20. The full paper, “Pain catastrophising as a risk factor for hospitalisation and readmissions in fast-track hip and knee arthroplasty,” appears in BJA Open, June 2026. (sciencedirect.com) (pubmed.ncbi.nlm.nih.gov) (ebiotrade.com)