An outcome study on average length of stay following total hip and knee replacement

doi:10.1016/S1361-3111(02)00055-9

Journal of Orthopaedic Nursing

Volume 6, Issue 3, August 2002, Pages 161-169

https://doi.org/10.1016/S1361-3111(02)00055-9 Get rights and content

Abstract

Getting people back into their homes earlier following total hip and knee replacement (THR/TKR) has the potential to result in better health outcomes. The study wanted to establish whether variation in the inpatient length of stay (LOS) for total joint replacement patients is associated with variation in the short-term outcome obtained, the problem and complication rates encountered and the variation in the care inputs received by patients in the immediate post-discharge period. Patient choice and satisfaction issues formed the hub of this work. The study design was prospective observational and carried out in the main elective orthopaedic unit for Northern Ireland. Four hundred patients undergoing unilateral primary total hip or knee replacement surgery were recruited. Outcome measures used were Oxford hip and knee scores at 3–12 months post-surgery; a SF36 at 12 months post-surgery; EuroQol; Barthel ADL's index and use of post-discharge resources, readmission, and complication rates. There was a very significant difference (in terms of improvements in scores) for patients comparing pre- and post-surgery outcomes. Improvement was noted for all groups – t-test (paired sample) VHS p<0.0005. Importantly there was no significant difference in outcome between short and long stay (not significant at the 5% level – using independent samples t-test – for equality of means).

Comprehensive studies of the effects on patient outcomes due to reduced length of hospital stay are rare. Many studies are very small and superficial in nature. This study gets to grips with the real issues and looks particularly at the orthopaedic nurses role.

Section snippets

Background

Patient expectations, quality issues and the rising costs of health care have challenged health professionals to provide comprehensive care to patients beyond that provided in the acute care setting. The outcomes unit at Musgrave Park Hospital (MPH) (O'Brien & Beverland 1998) is firmly wedded to the quality agenda, this includes a commitment to developing a hospital process that facilitates both clinical outcome measurement and continuous quality improvement ensuring that patients are very much

Aims and objectives

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To evaluate the difference in the quality of care following discharge for 400 patients discharged at day 4–5 or day 8–10 following THR/TKR.
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To evaluate multiprofessional problems in the provision of medical or social care services.
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To evaluate the patients' and their family's perspective of there discharge plan.
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To evaluate the carers' perspective of their discharge plan.
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To evaluate the impact on the GP and community care team of early discharge.
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To evaluate the variation in Musgrave Park's

Main measures

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The quality and outcome of discharge planning.
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Readmission rates.
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Duration of stay.
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Length of stay and its appropriateness.
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Patients health and satisfaction.
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Problems and core `complications' after discharge.
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Pain audit score at day 10.
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Review of aftercare services, e.g. physiotherapy and OT services on discharge and a survey of the outcomes team role for early discharge patients only.

Sample

A research nurse, who was independent of the outcomes unit team, was appointed to manage the project for a period of

Results

At the outset of this study the average LOS for short stay knees was 6.8 days and for long stay knees 8.2 days, for short stay hips it was 5.7 days and for long stay hips 7.2 days. This had changed slightly during the period of the study.

To evaluate the quality and outcome of discharge planning it was important to demonstrate the outcome in terms of when it started and when it was actually completed. This is outlined in Table 8, Table 9, Table 10.

Each table displays the distribution of “actual

Conclusion

This study has produced data that will reassure the advocates of earlier discharge. There was a very significant difference (in terms of improvements in scores) for patients comparing pre- and post-surgery outcomes. Improvement was noted for all groups – t-test (paired sample) VHS p<0.0005. Importantly there was no significant difference in outcome between short and long stay (not significant at the 5% level – using independent samples t-test – for equality of means). In summary the operation

Acknowledgements

The author would like to thank Staff Nurses Clodagh Willianis and Julie Orr for the collection of data for this article.

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We sought quantitative results from the lead authors of the 11 studies for which data on preoperative psychological health and length of stay had been collected but not reported. An author of one the 11 studies provided us with additional data, which we included in our review25; 10 studies remained excluded using this approach.26-33 Results of this review remained inconclusive with the included 5 studies, and, therefore, we sought data from 10 authors who did not separate data for primary total knee arthroplasty procedures from those of other procedures, such as total hip arthroplasty.
To systematically review the literature to determine if preoperative psychological health affected hospital length of stay among adults following primary unilateral total knee arthroplasty.
Systematic review. We searched 6 online databases for original research published before December 31, 2016, that investigated adults undergoing primary unilateral total knee arthroplasty.
We included studies that used any measure of preoperative psychological health and reported length of stay, irrespective of study design. We excluded studies that considered participants with cognitive impairment or substance abuse; studies that considered participants who experienced revision, bilateral or hip surgery; and studies that did not have full text available in English.
One review author screened 438 titles and abstracts for inclusion. Another author reviewed a 10% sample of excluded studies for adherence to the review protocol, with no violations observed. For all included studies, 2 authors independently extracted data from each study using a form designed a priori and independently assessed study quality according to the Joanna Briggs Checklist for Cohort Studies.
In view of the heterogeneity of the included studies, we present a narrative synthesis . Of the 7 included studies, 5 reported statistically significant increases in hospital length of stay among those with worse preoperative psychological health. These differences were often <1 calendar day, and, therefore, the clinical significance of these results remains unknown, but the potential to reduce health care costs may still be significant.
Adults experiencing worse preoperative psychological health before total knee arthroplasty may have a longer hospital stay compared to those with unremarkable psychological health.
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An outcome study on average length of stay following total hip and knee replacement

Abstract

Section snippets

Background

Aims and objectives

Main measures

Sample

Results

Conclusion

Acknowledgements

Mayo Clin. Proc.

J. Orthop. Nursing

J. Orthop. Nursing

J. Orthop. Nursing

The hospital cost of total hip arthroplasty

J. Bone Joint Surg.

Does shorter length of stay affect the outcome and costs of hysterectomy in Southern England?

J. Epidemiol. Community Health

Using patient reports to assess health related quality of life after total hip replacement

Qual. Life Res.

The problem of `noise' in monitoring patient-based outcomes: generic disease-specific and site-specific instruments for total hip replacement

J. Health Policy Res.

Reduced length of stay and improved appropriateness of care with a clinical path for total knee and hip arthroplasty

J. Qual. Improvement

Opportunities for control of hospital costs for total knee arthroplasty

Clin. Orthop.

Total hip replacement

Qual. Health Care

Comparative measurement sensitivity of short and longer health status instruments

Med. Care

Overall long-term impact of total hip and knee joint replacement surgery on patients with osteoarthritis and rheumatoid arthritis

Br. J. Rheumatol.