Overnight or Short Stay Joint Replacements in the Public and Private settings: An Australian Experience.

Authors

  • Sol Qurashi The Hip and Knee Clinic, Harbourcity Orthopaedics, Sydney, NSW, Australia; Nepean Hospital, Penrith, NSW, Australia; Canterbury Hospital, Campsie, NSW, Australia
  • Supreet Bajwa The Hip and Knee Clinic, Harbourcity Orthopaedics, Sydney, NSW, Australia
  • Sam Aktas The Hip and Knee Clinic, Harbourcity Orthopaedics, Sydney, NSW, Australia
  • William Bestic Royal North Shore Hospital, St. Leonard’s, NSW, Australia
  • Jason Chinnappa AOA https://orcid.org/0000-0002-4077-4938

DOI:

https://doi.org/10.15438/rr.11.1.283

Keywords:

Knee replacement, Hip replacement, Arthroplasty, Enhanced recovery after surgery, Cost-effectiveness

Abstract

Introduction:

In today’s post COVID 19 world, many healthcare systems have been pushed past the brink of economic sustainability. With Total Hip (THR) and Knee Replacements (TKR) being a few of the biggest ticket items, the need to adopt methods that improve quality of care & reduce unnecessary costs, is imperative. In this context, we report our experience with a Short Stay / Overnight joint replacement model using an ERAS (Enhanced Recovery After Surgery) Protocol which promotes rapid post-operative recovery and a decreased LOS without an increase in complications or readmission rates.

 

Method:

Retrospective collection of clinical & demographic data was undertaken for 114 consecutive patients undergoing primary THR or TKR by a single surgeon between 1 January 2018 and 19 March 2020 at 2 hospitals (1 public, 1 private). The data was analyzed for LOS, complications & readmission rates within 90 days after surgery.

 

Results:

In THR (n=93) and TKR (n=21), mean LOS was1.54 nights (range 0 - 4). 8 patients were discharged to a rehabilitation facility, the remaining 106 were discharged home. 2 patients were readmitted within 90 days of surgery - one with a periprosthetic fracture and the other for an unrelated respiratory illness.

 

Conclusion:

The implementation of a Short Stay model and associated ERAS protocols in both the public and private hospital settings reduced LOS without a concomitant increase in postoperative complications or readmission rates.

References

Ackerman I, Bohensky M, de Steiger R, Brand C, Eskelinen A, Fenstad A et al. Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 2003 to 2013: an international, population-level analysis. Osteoarthritis and Cartilage. 2017;25(4):455-461.

Ackerman I, Bohensky M, Zomer E, Tacey M, Gorelik A, Brand C et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskeletal Disorders. 2019;20(1).

Coronavirus set to punch $360b hole in Budget. Here’s how you might pay for it [Internet]. 2020 [cited 2020 May 12]. Available from: https://www.abc.net.au/news/2020-05-11/economic-cure-post-coronavirus-is-tax-reform/12227760

Hoffmann JD, Kusnezov NA, Dunn JC, Zarkadis NJ, Goodman GP, Berger RA. The shift to same-day outpatient joint arthroplasty: A systematic review. J Arthroplasty. 2018;33(4):1265–74.

RACS Surgical Practice Variation Report – Orthopaedic procedures 2016,

Sarpong NO, Boddapati V, Herndon CL, Shah RP, Cooper HJ, Geller JA. Trends in length of stay and 30-day complications after total knee arthroplasty: An analysis from 2006 to 2016. J Arthroplasty. 2019;34(8):1575–80.

Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79(2):168–73.

Sutton JC 3rd, Antoniou J, Epure LM, Huk OL, Zukor DJ, Bergeron SG. Hospital discharge within 2 days following total hip or knee arthroplasty does not increase major-complication and readmission rates. J Bone Joint Surg Am. 2016;98(17):1419–28.

Auyong DB, Allen CJ, Pahang JA, Clabeaux JJ, MacDonald KM, Hanson NA. Reduced length of hospitalization in primary total knee arthroplasty patients using an updated enhanced recovery after orthopedic surgery (ERAS) pathway. J Arthroplasty. 2015;30(10):1705–9.

Meyers S, Reuben J, Cox D, Watson M. Inpatient cost of primary total joint arthroplasty. The Journal of Arthroplasty. 1996;11(3):281-285.

Onggo JR, Onggo JD, De Steiger R, Hau R. The efficacy and safety of inpatient rehabilitation compared with home discharge after hip or knee arthroplasty: A meta-analysis and systematic review. J Arthroplasty. 2019;34(8):1823–30.

Ibrahim M, Khan M, Nizam I, Haddad F. Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review. BMC Medicine. 2013;11(1).

Miller T, Thacker J, White W, Mantyh C, Migaly J, Jin J et al. Reduced Length of Hospital Stay in Colorectal Surgery after Implementation of an Enhanced Recovery Protocol. Anesthesia & Analgesia. 2014;118(5):1052-1061.

Mayhew D, Mendonca V, Murthy B. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74(3):373-379.

Nassar I, Fahey J, Mitchell D. Rapid recovery following hip and knee arthroplasty using local infiltration analgesia: length of stay, rehabilitation protocol and cost savings. ANZ Journal of Surgery. 2020;90(3):355–9.

Christelis N, Wallace S, Sage C, Babitu U, Liew S, Dugal J et al. An enhanced recovery after surgery program for hip and knee arthroplasty. Medical Journal of Australia. 2015;202(7):363-368.

Ljungqvist O, Scott M, Fearon K. Enhanced Recovery After Surgery. JAMA Surgery. 2017;152(3):292.

Homburger J, Meiler S. Anesthesia drugs, immunity, and long-term outcome. Current Opinion in Anaesthesiology. 2006;19(4):423-428.

Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. International Orthopaedics. 2014;39(4):653-658.

Bjerregaard L, Hornum U, Troldborg C, Bogoe S, Bagi P, Kehlet H. Postoperative Urinary Catheterization Thresholds of 500 versus 800 ml after Fast-track Total Hip and Knee Arthroplasty. Anesthesiology. 2016;124(6):1256-1264.

Kehlet H, Aasvang E. Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?. F1000Research. 2015;4:1449.

Chaumeron A, Audy D, Drolet P, Lavigne M, Vendittoli P. Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function. Clinical Orthopaedics and Related Research®. 2013;471(7):2284-2295.

Maessen J, Dejong C, Hausel J, Nygren J, Lassen K, Andersen J et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. British Journal of Surgery. 2007;94(2):224-231.

Husted H, Lunn T, Troelsen A, Gaarn-Larsen L, Kristensen B, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty?. Acta Orthopaedica. 2011;82(6):679-684.

Khan S, Malviya A, Muller S, Carluke I, Partington P, Emmerson K et al. Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthopaedica. 2013;85(1):26-31.

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Published

2021-10-12

How to Cite

Qurashi, S., Bajwa, S., Aktas, S., Bestic, W., & Chinnappa, J. (2021). Overnight or Short Stay Joint Replacements in the Public and Private settings: An Australian Experience. Reconstructive Review, 11(1). https://doi.org/10.15438/rr.11.1.283

Issue

Section

Clinical/Surgical Audit

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