Does obesity, duration of symptoms and pre-operative knee movements amend discharge readiness and outcomes following total knee arthroplasty?

<p><strong>Background</strong>: Total knee arthroplasty (TKA) being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants and in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of hospital stay yet improving the functional outcome with better patient satisfaction.</p><p><strong>Methods</strong>: The study design is a retrospective analysis of 1022 patients of primary elective TKA, performed in our institution. The targeted indicators were sex, body mass index (BMI), pre-operative knee range of movements (ROM), knee deformity and duration of symptoms were analyzed.</p><p><strong>Results:</strong> Analyzing these patients, we found the average LOS is 6.4 days, and obesity, pre-op ROM and deformity all play a role to delay the discharge readiness in the patients. Our study showed that LOS after TKA is multifactorial.</p><p><strong>Conclusions:</strong> In acute setting for readiness of discharge the preoperative knee movements, deformity and patients’ functional abilities can be used to segregate patients who may require close monitoring or intensive physiotherapy.</p>

Examining the course of transitions from hospital to home-based palliative care: A mixed methods study

Background: Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care. Aim: Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions. Design: Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3–4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and post discharge-coping. A qualitative interview was conducted at both visits. Data were analyzed separately and integrated using a merged transformative methodology, allowing us to compare and contrast the data. Setting and participants: Study was set in two tertiary hospitals in Toronto, Canada. Adult inpatients ( n = 25) and their caregivers ( n = 14) were eligible if they received a palliative care consultation and transitioned to home-based palliative care. Results: Results were organized aligning with the scales; finding low discharge readiness (5.8; IQR: 1.9), moderate transition quality (66.7; IQR: 33.33), and poor discharge-coping (5.0; IQR: 2.6), respectively. Positive transitions involved feeling well supported, managing medications, feeling well, and having healthcare needs met. Challenges in transitions were feeling unwell, confusion over medications, unclear healthcare responsibilities, and emotional distress. Conclusions: We identified aspects of these three domains that may be targeted to improve transitions through intervention development. Identified discrepancies between the data types should be considered for future research exploration.