Functional Recovery and Timing of Hospital Discharge After Primary Total Hip Arthroplasty

Abstract

Background: Early discharge programmes in hospitals are encouraged to increase financial efficiency and bed availability, but standards of clinical care must not be compromised. Criteria for safe hospital discharge must be established and objective data are needed to assess how rapidly patients can achieve these discharge criteria. Methods: A prospective study was performed on 65 patients (mean age = 71 years) scheduled for primary total hip arthroplasty (THA). The Modified Barthel Index (MBI) was measured pre-operatively and postoperatively at set intervals to assess recovery of function after THA. A score of 90 out of a possible 100 was used as a discharge criterion and indicated that the patient was functionally independent for safe hospital discharge. In addition, a combined score for thigh flexion and extension isokinetic peak strength was recorded for each patient before and after surgery. The number and nature of comorbidities and complications were also recorded. Results:The length of hospital stay in this sample varied from 5 to 39 days. The MBI scores increased rapidly between days 3 and 5, then began to plateau from day 8 onwards. Based on the MBI, 58% of patients were fit for discharge at or before day 8. The remainder were fit for discharge from day 10 onwards (mean = 14.2 days). The latter group who required an extended hospital stay were older ( P = 0.003). had more identified comorbidities ( P = 0.01) and were weaker in their hip musculature prior to surgery ( P = 0.01). compared to those who were discharged by day 8. A logistic regression analysis indicated that the pre-operative MBI score and hip strength score were strong predictors of timing for hospital discharge. Conclusions: A clinical pathway with functional milestones laid out over 8 days would be an appropriate criterion for the discharge of the majority of patients. However, approximately 40% of the patients presented in this study required a longer hospital stay before the criteria for safe discharge could be achieved. These patients can be identified pre-operatively by screening their MBI and composite hip strength scores.

Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients

“…We found that LOS was associated with certain patient characteristics. Increasing age was found to correlate with increasing LOS, which is in accordance with other, comparable studies (Kim et al 1993, Wang et al 1998, Watkins et al 1999, Hayes et al 2000. Women had longer stays than men and patients living alone stayed longer, which has also been shown in most studies (Rissanen et al 1996, Liebergall et al 1999, Watkins et al 1999, Hayes et al 2000.…”

“…There is no clear-cut explanation for this finding. Co-morbidities resulted in increased LOS-a finding shared by others (Wang et al 1998, Wasielewski et al 1998, Hayes et al 2000. Preoperative use of walking aids was associated with increased LOS.…”

“…The investigators have approached these criteria differently, however. Extraordinary resources have been allocated to fast-track units, patients have been transferred to more or less intensive rehabilitation units shortly after surgery instead of being discharged directly to their homes, and few, if any, specific determinants or predictors of patient characteristics of early or delayed recovery have been identified (Wang et al 1998, Weingarten et al 1998, Dowsey et al 1999, Watkins et al 1999, Hayes et al 2000, Pearson et al 2000, Healy et al 2002.…”

Blood Management May Have an Impact on Length of Stay After Total Hip Arthroplasty

“…Some of the results that were only significant in the univariate analysis might be accounted for by different medical comorbidities of the patients, and the lack of the American Society of Anesthesiologists (ASA) grading for our cohort is a limitation of this study. Medical comorbidities clearly correlate with prolonged course of hospitalization [6,8,42], especially with the ASA scores of 3 and 4 [12]. Another limitation is the retrospective nature of the data, as well as the lack of reported outcome scores and operative times.…”

“…Medical comorbidities clearly correlate with prolonged course of hospitalization [6,8,42], especially with the ASA scores of 3 and 4 [12]. In addition, univariate analysis involves measurement of one variable at a time, while multivariate analysis involves multiple variable and accounts for confounding effect.…”