The consequences of early discharge after hip arthroplasty for patient outcomes and health care costs: comparison of three centres with differing durations of stay

Hunt, Gillian R.; Crealey, Grainne; Murthy, B. V. S.; Hall, George; Constantine, Philippa; O’Brien, Seamus; Dennison, Janice; Keane, P.; Beverland, David; Lynch, Martin C.; Salmon, Peter

doi:10.1177/0269215509339000

Cited by 36 publications

(55 citation statements)

References 27 publications

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“…It has been suggested that physiotherapy provided after discharge is not necessary to achieve excellent short-term recovery. 616 The clinical reasoning around the decision not to provide additional physiotherapy following THR was not explored but may reflect the uncertain evidence supporting long-term benefits of physiotherapy after hip replacement, 253 despite many patients continuing to have persistent muscle weakness and functional deficits compared with their age-matched peers 592 up to 2 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Blom

Artz

Beswick

et al. 2016

Programme Grants Appl Res

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms PROGRAMME GRANTS FOR APPLIED RESEARCH VOLUME 4 ISSUE 12 AUGUST 2016 ISSN 2050 DOI 10.3310/pgfar04120Improving patients' experience and outcome of total joint replacement: the RESTORE programme Ashley W Blom, Neil Artz, Andrew D Beswick, Amanda Burston, Paul Dieppe, Karen T Elvers, Rachael Gooberman-Hill, Jeremy Horwood, Paul Jepson, Emma Johnson, Erik Lenguerrand, Elsa Marques, Sian Noble, Mark Pyke, Catherine Sackley, Gina Sands, Adrian Sayers, Victoria Wells and Vikki Wylde Improving patients' experience and outcome of total joint replacement: the RESTORE programme ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10070. The contractual start date was in December 2008. The final report began editorial review in September 2014 and was accepted for publication in August 2015. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accurac...

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Section: Discussionmentioning

confidence: 99%

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Blom

Artz

Beswick

et al. 2016

Programme Grants Appl Res

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“…The advantages of fast-track are well documented from both socio-economic perspectives (Andersen et al, 2009;Hunt et al, 2009;Larsen et al, 2009) and from the perspective of improved outcome for patients (Dowsey et al, 1999;Kehlet, 2013;Kehlet and Wilmore, 2008) including reduced incidence of complications (Husted et al, 2010b(Husted et al, , 2010cSavaridas et al, 2013). Furthermore, the readmission rate is reported not to be higher in a fast-track setting compared with a conventional setting (Husted et al, 2010b).…”

Section: Introductionmentioning

confidence: 99%

Nursing in fast-track total hip and knee arthroplasty: A retrospective study

Specht

Kjærsgaard‐Andersen

Kehlet

et al. 2015

International Journal of Orthopaedic and Trauma Nursing

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“…23 A previous report showed that median stay of three days can be achieved with no more rehabilitation input than routine in-hospital physiotherapy, with no impairment to clinical outcomes and without cost-shifting. 4 The present report shows that this median stay can be achieved with no detriment to patient experience and, by contrast, with indications of improved experience. The evidence therefore shows no benefit of prolonging patients' hospital stay beyond a median of three days after this procedure.…”

Section: Discussionmentioning

confidence: 44%

“…In primary hip arthroplasty patients six weeks postoperatively, patient-reported outcomes, including quality of life, mental state and physical function, were all at least as good in a unit with accelerated discharge as in two units with longer stay. 4 For shorter stay to be adopted more widely it needs to be shown to be acceptable to patients, whose evaluations of care have become important in health policy. The aim of this study was to compare patients' evaluation of hip arthroplasty between a unit with accelerated discharge and two comparison units representing different models of care in the UK.…”

Section: Introductionmentioning

confidence: 99%

Patient evaluation of early discharge after hip arthroplasty: development of a measure and comparison of three centres with differing durations of stay

et al. 2013

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Objective: We compared patients' evaluation of care between a surgical unit with a rapid discharge policy and two comparison units to test the hypothesis that the centre with rapid discharge has outcomes that are not inferior to those of the comparison sites. Design: Cross-sectional cohort study. Subjects: Consecutive consenting patients undergoing primary hip arthroplasty during 12 months in: a unit that had reduced postoperative stay to median three days; a specialised orthopaedic surgery treatment centre with median stay of five days; a traditional unit with median stay of six days (N = 316, 125, 119, respectively). Methods: Six weeks postoperatively, patients completed a specially developed questionnaire measuring their evaluation of care and recovery, together with measures of function and quality of life for validation purposes. Results: Factor analysis of questionnaire responses identified two independent components of patients' evaluation: problems in staff care and problems in physical recovery. Neither component was impaired in the unit with rapid discharge: similar proportions of patients reported recovery problems in each site (odds radios (ORs) for the two comparators versus unit with rapid discharge: 0.96, 1.18); and more patients reported care problems in the two comparator sites (ORs 2.97, 2.16). 855Conclusion: Duration of stay after primary hip arthroplasty can be reduced to three days without intensive pre-or postoperative care, without detriment to patient evaluation.

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The consequences of early discharge after hip arthroplasty for patient outcomes and health care costs: comparison of three centres with differing durations of stay

Abstract: Short postoperative stay after hip arthroplasty can be achieved without intensive patient preparation or post-discharge care and without compromising short-term patient outcome or increasing health care costs. Longer term follow-up is needed.

Cited by 36 publications

References 27 publications

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Nursing in fast-track total hip and knee arthroplasty: A retrospective study

Patient evaluation of early discharge after hip arthroplasty: development of a measure and comparison of three centres with differing durations of stay

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