Abstract
Aims
Recent NHS reforms have incentivised reduction in length of stay, with the UK department of health expecting health trusts to reduce bed days and ultimately reduce overall costs. The aim of this study was to identify avoidable causes for protracted hospital admission following total hip arthroplasty (THA) or total knee arthroplasty (TKA) within a fast-track unit.
Methods
During a 6-month period, 535 consecutive patients underwent primary THA or TKA under the care of a single surgeon. All patients with a post-operative stay of greater than 72 h were identified, and reasons for delayed discharge were determined.
Results
The majority of arthroplasty patients were discharged within 3 days post-operatively. Twenty-one per cent of THA patients and 25 % of TKA patients remained as inpatients for greater than 72 h. For the THA population, this equates to 43 % of bed days used by 21 % of patients, and for the TKA population, 44 % of bed days were used by 25 % of patients. The major factor within both groups for delayed discharge was attributed to inadequate social support.
Conclusions
Delayed discharge can never be totally prevented. This unit aims to develop improvement in social work provision, with a greater focus on pre-admission discharge planning to reduce the number of delayed discharges and ultimately reduce the cost burden of joint replacement surgery. It is not conducive with the ethos of fast-track arthroplasty to only identify social circumstances upon admission.
Similar content being viewed by others
References
National Joint Registry for England and Wales (2010) 7th Annual report
Crowninshield RD, Rosenberg AG, Sporer SM (2006) Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 443:266–272
Kurtz S, Ong K, Lau E (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785
National Audit Office (2000) Hip replacements: getting it right first time. The Stationery Office, London
National Audit Office (2003) Hip replacements: an update. The Stationery Office, London
Healthcare Cost and Utilization Project (HCUP) (2007) Statistical brief #34. Agency for Healthcare Research and Quality, Rockville
Dowsey MM, Kilgour ML, Santamaria NM, Choong PF (1999) Clinical pathways in hip and knee arthroplasty: a prospective, randomised controlled study. Med J Aust 170:59–62
Gregor C, Pope S, Werry D, Dodek P (1996) Reduced length of stay and improved appropriateness of care with a clinical path for total knee or hip arthroplasty. Joint Commiss J Qual Improv 22:617–628
Ahmad A, Purewal TS, Sharma D, Weston P (2011) The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards. Clin Med 11(6):524–528
Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL (2000) Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplast 15:448–452
Watkins J, Bryan S, Muris N, Buxton M (1999) Examining the influence of picture archiving communication systems and others factors upon the length of stay for patients with total hip and total knee replacements. Int J Technol Assess Health Care 15(3):497–505
Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79(2):168–173
Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D (2005) A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am 87(4):701–710
Zakai N, Katz R, Hirsch C, Shlipak M, Chaves PM, Newman AB, Cushman M (2005) A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the cardiovascular health study. Arch Intern Med 165(19):2214–2220
Hunt GR et al (2009) Early discharge following hip arthroplasty: patients’ acceptance masks doubts and concerns. Health Expect 12(2):130–137
National joint registry for England and Wales (2009) 6th Annual report. Hem-stead, England. The National Joint Registry (NJR) centre. Available from: http://www.njrcentre.org.uk/njrcentre/AbouttheNJR/Publicationsan-dreports/Annualreports/tabid/86/Default.aspx
Lohmander LS, Gerhardsson M, Rollof J, Nilsson PM, Engstrom G (2009) Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass. A population-based prospective cohort study. Ann Rheum Dis 68:490–496
Conflict of interest
The authors declare that they have no conflict of interest and no funding was provided for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Napier, R.J., Spence, D., Diamond, O. et al. Modifiable factors delaying early discharge following primary joint arthroplasty. Eur J Orthop Surg Traumatol 23, 665–669 (2013). https://doi.org/10.1007/s00590-012-1053-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-012-1053-5