Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement

2014 ◽  
Vol 38 (3) ◽  
pp. 265 ◽  
Author(s):  
Zoe L. Maidment ◽  
Brenton G. Hordacre ◽  
Christopher J. Barr
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Hip ◽  
Physiotherapy Service ◽  
Medical Issues ◽  
Total Knee

Objective The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement. Methods A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. Results There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0–6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0–5.0 days) for 7-day physiotherapy service (U = 1443.5, z = –4.62, P = 0.001). However, hospital LOS was not reduced (P = 0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U = 518.0, z = –4.20, P = 0.001). However, hospital LOS was again no different (P = 0.309). For THR there was no difference in physiotherapy LOS (P = 0.060) or hospital LOS (P = 0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects. Conclusions Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge. What is known about the topic? Previous studies have investigated the effect of increasing physiotherapy services following total hip replacement (THR) and total knee replacement (TKR) surgery, with varying reports of decreased or unaffected hospital length of stay (LOS). What does this paper add? This study investigates both hospital and physiotherapy LOS individually for THR and TKR patients following an increase from a 5- to 7-day physiotherapy service. Where physiotherapy LOS decreased and hospital LOS did not, delays in hospital discharge were investigated. What are the implications for practitioners? Additional physiotherapy services decrease physiotherapy LOS for TKR patients, but administrative aspects of hospital discharge must improve to reduce hospital LOS.

Impact of Tranexamic Acid in Total Knee and Total Hip Replacement

2016 ◽  
Vol 30 (1) ◽  
pp. 89-93 ◽  
Author(s):  
Jaclyn A. Boyle ◽  
Mate M. Soric
Keyword(s):  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Tranexamic Acid ◽  
Usual Care ◽  
Total Hip Replacement ◽  
Clinical Benefit ◽  
Hip Replacement ◽  
Total Hip ◽  
Total Knee ◽  
Net Clinical Benefit

Objective: To evaluate the net clinical benefit of tranexamic acid use in patients undergoing total knee or total hip replacement. Methods: This is a retrospective study of patients undergoing total knee or total hip replacement. The primary outcome was the net clinical benefit of tranexamic acid use. Secondary outcomes included length of stay, incidence of venous thromboembolism, change in hemoglobin, and number of units of blood transfused. Results: Four hundred and six patients were screened for inclusion and 327 patients met inclusion criteria; 174 patients received tranexamic acid versus 153 patients who received usual care. Tranexamic acid demonstrated a positive net clinical benefit versus usual care (40.8% vs 13.7%, P < .01) but did not affect length of stay (3.39 vs 3.37 days, respectively, P = .76). Venous thromboembolism was comparable between groups (2.3% vs 0.7%, P = .38). Average change in hemoglobin and need for transfusion were lower in the treatment group versus the usual care group, respectively (3.46 vs 4.26 mg/dL, P < .01). Conclusion: Tranexamic acid demonstrated a significant benefit in decreasing change in hemoglobin as well as the need for blood transfusion with no increase in the risk of venous thromboembolism in patients undergoing total knee or total hip replacement.

scholarly journals Improving Orthopedic Care Delivery Through Digital Engagement

Iproceedings ◽  
10.2196/16305 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e16305
Author(s):  
Lisa Biernat ◽  
Carly E Milliren ◽  
Jon Rauen ◽  
Bill Lindsay ◽  
Betsy Weaver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hip Replacement ◽  
Skilled Nursing Facility ◽  
Patient Activation ◽  
Hospital Length Of Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Hip ◽  
Total Knee ◽  
Ed Visits

Background Patient activation has been hypothesized to improve medical and surgical outcomes by increasing patient involvement in the care plan. We tested this hypothesis by utilizing a patient activation tool in a population of adults having total hip or total knee replacement. We hypothesized that patient activation would be associated with increased discharge to home as opposed to a skilled nursing facility, reduced hospital length of stay, decreased inpatient readmissions, and decreased emergency department (ED) visits. Objective Using an email patient activation tool, we sought to increase patients’ involvement in their care before and after total joint replacement. Outcomes examined included day of surgery cancellation, length of hospital stay, discharge to home vs discharge to a skilled nursing facility, any ED visit within 30 days of discharge, and any inpatient readmission within 30 days of discharge Methods This was a quasi-experimental design comparing Jan-Jun 2017 to Jan-Jun 2018. We instituted an email patient activation tool for all patients with total knee or total hip replacement surgery beginning in January 2018. This tool was integrated with the electronic medical record system during the six month study period and patients could opt out at anytime if they desired. The tool was designed to prepare patients both educationally and emotionally for their operation with multiple easy-to-read emails starting from the time they were scheduled for surgery through six months postop. Percent of emails opened and clicked were used as measures of engagement for the intervention participants. Results Of the 2,027 TJR patients included, 720 were hip patients and 1,307 were knee patients. Pre- and postintervention groups were similar in gender and age. For hip replacement patients, length of stay was nearly 1/4 day lower in the postintervention group (β=-0.23; P=.001) after adjusting for gender, age and insurance; ED visits were lower among the postintervention group (OR=0.45; P=.05) after adjusting for gender, age and insurance; and postintervention patients were less likely to have day of surgery cancellation, any revisit (ED or readmission), and were more likely to be discharged home. However, these associations did not reach statistical significance. Conclusions Among patients who received the intervention, higher engagement was significantly associated with positive changes in almost all outcomes. Use of the digital patient activation tool demonstrated significant savings in length of stay and reduced ED visits among hip replacement patients. Although just under 50% of patients in the intervention group were enrolled to use the tool, these findings were still significant even when non-participants were included in the postintervention group.

Total Hip Replacement Provokes Endothelial Dysfunction

Angiology ◽  
2018 ◽  
Vol 69 (10) ◽  
pp. 871-877 ◽  
Author(s):  
Peter Poredos ◽  
Ana Mavric ◽  
Lara Leben ◽  
Pavel Poredos ◽  
Mateja Kaja Jezovnik
Keyword(s):  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Total Hip Replacement ◽  
Postoperative Period ◽  
Hip Replacement ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Total Hip ◽  
Increased Risk ◽  
Cardiovascular Homeostasis

Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively. Baseline FMD was 12.3% and decreased a day after surgery to 7.3% ( P < .001). After 5 to 7 days, it gradually increased to 9.2%. However, on average, it was lower than before surgery ( P < .001). The median duration of THR was 85.0 (65.0-100.0) minutes, the average hospital length of stay was 7 days. Total hip replacement is associated with an immediate decrease in FMD which remains significantly decreased 5 to 7 days after the surgery compared with the preoperative value. These results indicate that surgery provokes endothelial dysfunction and deteriorates cardiovascular homeostasis. This effect could be involved in cardiovascular complications in the postoperative period.

Application of thrombelastography in primary total knee and total hip replacement

2019 ◽  
Vol 30 (6) ◽  
pp. 281-290
Author(s):  
Cheng Wang ◽  
Qiaohui Liu ◽  
Lei Sun ◽  
Guofeng Dai
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Total Hip ◽  
Total Knee ◽  
Primary Total Knee

Cost-effectiveness of telerehabilitation versus traditional care after total hip replacement: A trial-based economic evaluation

2019 ◽  
pp. 1357633X1986979 ◽  
Author(s):  
Mark Nelson ◽  
Trevor Russell ◽  
Kay Crossley ◽  
Michael Bourke ◽  
Steven McPhail
Keyword(s):  
Cost Effectiveness ◽  
Health Service ◽  
Hospital Discharge ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Randomised Trial ◽  
Total Hip ◽  
Time Burden ◽  
Traditional Care ◽  
The Cost

Introduction: Physical rehabilitation for total hip replacement patients following hospital discharge is beneficial; however, accessing rehabilitation is often challenging. Telerehabilitation helps negate access issues and is efficacious in total knee and hip replacement patients. This study aims to compare the cost-effectiveness of a telerehabilitation programme delivered remotely into patients’ homes versus traditional care for total hip replacement patients following hospital discharge. Methods: A cost-effectiveness (cost-utility) analysis was conducted from the perspective of a health service alongside a two-arm randomised controlled trial comparing telerehabilitation ( n=35) with in-person care ( n=35) following hospital discharge after total hip replacement. The primary analysis used an Incremental Cost-Effectiveness Ratio to compare the cost per Quality Adjusted Life Year (QALY) accrued in the telerehabilitation group versus in-person control using costs and effects data from the randomised trial. A secondary analysis was conducted whereby the time accrued by patients attending rehabilitation sessions (including travel time) was considered the “cost” (i.e. a time burden), rather than cost from the health service perspective. Results: Estimated mean differences in healthcare costs and QALYs gained were detected but were not significant. The estimated mean (95%CI) difference in cost of telerehabilitation versus in-person was –$28.90 (–$96.37 to $40.45), favouring the telerehabilitation group. The estimated mean (95%CI) difference in QALYs gained from telerehabilitation versus in-person was –0.0025 (–0.0227 to 0.0217). The estimated mean (95%CI) difference in time burden favoured less time burden for the telerehabilitation group (–4.21 (–4.69 to –3.74) hours). Discussion: Telerehabilitation in the total hip replacement population incurred similar costs and yielded similar effects to traditional in-person care. Telerehabilitation significantly reduced the time burden for patients and carers. These findings are valuable for healthcare providers seeking to implement accessible patient-centred rehabilitation services.

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