Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty
Background: Advanced rehabilitation pathway (ARP) after hip and knee arthroplasties is popular globally and is gaining ground in South Africa (SA). A multidisciplinary team in Rustenburg, SA, has implemented an ARP with the first same-day discharge (SDD) from hospital. The lack of evidence of physio...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Book |
| Published: |
AOSIS,
2022-05-01T00:00:00Z.
|
| Subjects: | |
| Online Access: | Connect to this object online. |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background: Advanced rehabilitation pathway (ARP) after hip and knee arthroplasties is popular globally and is gaining ground in South Africa (SA). A multidisciplinary team in Rustenburg, SA, has implemented an ARP with the first same-day discharge (SDD) from hospital. The lack of evidence of physiotherapy protocols within an ARP determined our study. Objectives: Determine and compare hospital length of stay (LOS) (hours), patient satisfaction (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), patient safety (30-day re-admission) and cost between the two cohorts. Method: A quantitative prospective patient (treatment) group receiving early mobilisation with increased frequency of physiotherapy on post-operative day zero (POD0) was compared to a conservatively managed retrospective historical (control) group following post-operative elective hip and knee arthroplasties. Results: Results for the prospective group which were significantly improved relative to the retrospective group included decreased LOS (median 7.650, p 0.001), less pain at 6 weeks (mean 16.20, standard deviation [SD] = 2.673, p 0.001), less stiffness (mean 5.82, SD = 1.214, p = 0.007), higher function (mean 54.87, SD = 8.544, p 0.001), lower hospital cost (mean R43 340, p 0.001) and physiotherapy cost (mean R1069, p 0.001), and total costs compared to the retrospective group (mean R117 062, p 0.001). Conclusion: Safe and cost-effective SDD is possible in an ARP with earlier mobilisation and increased frequency of physiotherapy on POD0. Clinical implications: Achieving safe SDD after hip and knee arthroplasty surgeries saved costs and improved patient satisfaction, with a decrease in LOS being beneficial for medical funders and stakeholders including government aiming to implement National Health Insurance (NHI) in the future. |
|---|---|
| Item Description: | 0379-6175 2410-8219 10.4102/sajp.v78i1.1755 |