Is It Time We Changed How We Measure Length of Stay for Hip and Knee Arthroplasty?

McCulloch, Robert E.; Cottingham, Paul; Chrismas, Bryna C. R.; Pearce, Oliver

doi:10.5435/jaaosglobal-d-17-00032

Cited by 12 publications

(21 citation statements)

References 13 publications

(11 reference statements)

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“…In Professor Pearce’s team’s writing on rapid recovery, it states that ‘mobilisation of patients is predominantly performed by physiotherapists and, to a lesser extent, the ward nurses’. 11 However, we have seen a paradigm shift in this where nursing staff have taken on responsibility for early mobilisation with impact. Due to the technique being embraced by nursing staff and the improved equipment made available, in the most recent 3 months of data all patients were mobilised on day 0.…”

Section: Resultsmentioning

confidence: 99%

Revolutionising rapid recovery: a quality improvement project in hip and knee replacement

et al. 2021

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With increasing bed pressures and an ageing population, there is a need to increase throughput and reduce the bed burden of joint replacements. These issues were recognised in North Devon and an enhanced recovery pathway was established. Enhanced recovery, which aims to optimise the patient journey and shorten the inpatient admission, was first adopted for hip and knee replacements in North Devon District hospital in 2011. The Rapid Recovery Group, comprised a multidisciplinary team involved in the perioperative patient pathway, formed in the third financial quarter of 2018/2019 (Q3). The group was tasked with the optimisation of the pathway for patients requiring hip and knee replacement from referral to 12 months postoperation. Representatives from the group visited a similar sized hospital with successful outcomes from their pathway in order to compare and then construct a new pathway based on observed practices. Multiple interventions were instigated, alongside continuous data collection, forming a combination of simultaneous and sequential Plan Do Study Act cycles. Interventions involved intraoperative local anaesthetic injection protocols, use of Taurus frames together with nurse-led mobilisation and trials of simplified drug charts. Information collected included type of surgery, length of stay, who mobilised patients and when. Mean length of stay in total hip and knee replacement has dropped from 3.6 to 2.4 days and 3.6 to 2.0 days respectively, comparing mean for the fiscal year 2018/2019 to 2019/2020, putting the hospital in the top 10 trusts in the country. With multiple changes occurring simultaneously, the impact of individual elements is difficult to isolate but the overall impact of the interventions is evident. A drastic improvement in the length of stay has been seen and the collaborative multidisciplinary approach has been pivotal to success.

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Section: Resultsmentioning

confidence: 99%

Revolutionising rapid recovery: a quality improvement project in hip and knee replacement

et al. 2021

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“…Outpatient total joint arthroplasties can be implemented safely, cost-effectively and are beneficial to patients. Increased LOS is associated with higher morbidity and mortality (Lazic et al 2018;McCulloch et al 2017). In SA, outpatient arthroplasty surgeries have not yet been performed.…”

Section: Introductionmentioning

confidence: 99%

“…Early mobilisation (patient ambulating or walking with an appropriate mobility aid away from the bed), plays an essential role in decreasing post-operative complications, including deep vein thrombosis (DVT), prosthesis-related infections and postural hypotension (Chen et al 2012;Dossett & Chesser 2017). Physiotherapy intervention also improves patients' function and muscle strength (Chen et al 2012;McCulloch et al 2017). When considering outcomes after total knee arthroplasty, Kolisek et al (2009) reported that joint range of motion (ROM) and function were comparable with the final follow-up for both patients having surgery out-and inhospital.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown that early mobilisation post-operative day 0 (POD 0) plays a significant role in decreased LOS (Lazic et al 2018;Masaracchio et al 2017;McCulloch et al 2017;Riemer et al 2017;Tayrose et al 2013;Yakkanti et al 2019). In a systematic review and meta-analysis of 17 studies, Masaracchio et al (2017) found that early initiation of rehabilitation on POD 0 decreases the LOS without increasing adverse events in patients following joint replacement surgery.…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal

Prinsloo

Keller

2021

S. Afr. j. physiother.

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Background: Accelerated rehabilitation pathway (ARP) decrease patients’ hospital length of stay (LOS). A lack of evidence exists on physiotherapy management and outcome as part of ARP in South Africa (SA). Our study will aim to determine whether early mobilisation and increased frequency of physiotherapy treatments for participants after hip or knee arthroplasty surgery on post-operative day 0 (POD 0) affect outcome.Methods/design: A quantitative prospective cohort study incorporating ARP on (n = 60) non-randomised elective hip and knee arthroplasty participants will be compared with a more conservatively managed historical control group (n = 60). The physiotherapy protocol includes early mobilisation and exercises 1–3 h post-operatively on POD 0 and a second mobilisation and exercise session, 1–2 h later. Outcomes measures are as follows: hours for LOS, the WOMAC measured pre-operatively, 6 weeks and 3 months post-operatively, 30-day readmission for safety and cost comparison between the prospective and historical cohorts. Descriptive statistics will be undertaken. A paired t-test will be used to analyse each of the outcome measures across the time periods if data are normally distributed. Length of stay, WOMAC score and cost data will be compared between the groups, using a Mann–Whitney U test. The occurrence of adverse events will be compared between the groups using Pearson’s chi-square tests. The confidence interval will be set at 95% and p = 0.05 will be considered statistically significant.Discussion: Globally, ARP’s are successfully implemented to manage patients presenting with hip and knee osteoarthritis (OA). Research investigating physiotherapy protocols in an ARP is lacking in the literature.Conclusion: Achieving the same-day discharge after hip and knee arthroplasty surgeries may help elective surgery backlogs and waiting lists in a more cost-effective manner.Clinical implications: The same day discharge after arthroplasty may be a cost-effective management option in the future.Protocol identification: Pan African Clinical Trial Registry, PACTR202103637993156.

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“…In addition, the average length of hospital stay after artificial joint replacement has decreased [2]. Modern artificial joint replacement technology allows surgical patients to be safely discharged within a short period of time after surgery [3,4].This trend of shorter length of hospital stay emphasizes the importance of pre-discharge patient education. A large proportion of postoperative adverse events may be avoided and can be prevented by better patient education and enhanced postoperative counseling [5].…”

Section: Introductionmentioning

confidence: 99%

Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate

Zheng

Geng

et al. 2019

J Orthop Surg Res

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Background: Follow-up after artificial joint replacement greatly helps achieve surgical outcomes. Mobile internet technology and mobile terminal equipment may increase the effectiveness of artificial joint replacement. However, only a few studies have evaluated the effectiveness of this technology. We aimed to analyze the reasons and outcomes of patients who used the instant messaging platform after undergoing artificial joint replacement. Methods: Among the 548 cases of arthroplasty (250 hips, 298 knees) performed between December 2015 and June 2018 in the Department of Joint Surgery of our institution; 358 (164 hip joints, 194 knee joints) participated in instant messaging platform consultation, whereas the remaining 190 (86 hip joints, 104 knee joints) participated in traditional telephone consultation, as a control group. Follow-up time was from December 2015 to August 2018 (follow-up period was 2-32 months). Data on age, sex, type of surgery, date of surgery, date of discharge, and length of hospital stay were collected from electronic medical records. Results: We analyzed the consultation contents of 358 patients who participated in instant messaging platform consultation. Counseling was mainly related to pain (13.6%), appointment review (12.4%), activity problems (10.5%), and incision problems (8.9%). Most problems were resolved through online guidance, with 8.4% of patients requiring only outpatient treatment and 2.5% of patients requiring rehospitalization. A total of 190 patients were followed up through traditional telephone consultation; 6.8% of patients required outpatient department treatment and 7.4% were eventually re-admitted. Conclusion: The instant messaging platform consultation service effectively informs patients of potential postoperative problems and helps resolve them. It allows early detection and management of postoperative adverse events, including problems related to medication, wound, and activity, thereby effectively reducing readmission rate.

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Is It Time We Changed How We Measure Length of Stay for Hip and Knee Arthroplasty?

Cited by 12 publications

References 13 publications

Revolutionising rapid recovery: a quality improvement project in hip and knee replacement

Revolutionising rapid recovery: a quality improvement project in hip and knee replacement

Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal

Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate

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