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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

¹ Division of Clinical Psychology, University of Liverpool, Liverpool, UK
² Clinical Research Support Centre, Education and Research Centre, Royal Group of Hospitals Trust, Belfast, UK
³ Department of Anaesthesia, Royal Liverpool University Hospital, Liverpool, UK
⁴ Department of Anaesthesia, St George's Hospital Medical School, University of London, London, UK
⁵ Outcomes Unit, Musgrave Park Hospital, Belfast, UK
⁶ Division of Physiotherapy, University of Liverpool, Liverpool, UK
⁷ Department of Orthopaedics, Musgrave Park Hospital, Belfast, UK
⁸ Department of Orthopaedics, Royal Liverpool University Hospital, Liverpool, UK

^* To whom correspondence should be addressed. E-mail: psalmon{at}liv.ac.uk.

	Abstract

Objective: To compare outcomes from hip arthroplasty 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 the comparison sites.

Design: Prospective cohort study.

Subjects: Consecutive consenting patients receiving primary hip arthroplasty during 12 months beginning July 2006 in three UK National Health Service surgical units. One has shortened postoperative stay to median three days; one was a new treatment centre with median stay of five days; the third was a traditional unit with median stay of six days (N = 316, 119, 87, respectively).

Methods: Patients were assessed preoperatively and six weeks postoperatively. The primary indicator of function was the Oxford Hip Score. Additional secondary measures included further self-report indicators of function and quality of life and health service costs.

Results: Patient outcome in the unit with rapid discharge was not impaired by comparison with the other sites on any measure: Oxford Hip Score decreased from 49 to 27 in the short-stay unit, from 40 to 30 in the treatment centre and from 43 to 32 in the traditional unit. Cost of arthroplasty was least in the short-stay unit, although there was potential for cost savings in each.

Conclusion: 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.

First published on October 28, 2009
Clinical Rehabilitation 2009, doi:10.1177/0269215509339000


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