A very common question that the surgeon, the team, the physiotherapists and the ward nurses are asked to answer is whether a patient undergoing total joint replacement who lives alone at home can return home safely after the operation. Rehabilitation centres of course provide valuable services to this group of patients, but there is a subgroup who could in theory manage the demands of daily life even after such major surgery.
A recent study published in the British journal “The Journal of Bone and Joint Surgery” sought to answer this question by assessing the safety and effectiveness of discharging patients directly home after primary total hip arthroplasty or knee arthroplasty.
910 consecutive patients who underwent primary unilateral total hip or knee arthroplasty over a period of eight months were studied prospectively. The patients discharged directly home who lived alone for the first two weeks after surgery were identified as the study group and were compared with a group of patients who did not live alone at home, which formed the control group. The primary outcomes took account of the complications of the first 90 days, including readmission, a visit to the emergency department or a visit to the clinic. The functional results, the patient's subjective satisfaction, the relief of pain and the return to everyday activities were also assessed.
During the study period 874 patients were discharged directly home and only 36 patients were sent to a rehabilitation centre. Of those discharged home, 769 were included in the final analysis, giving a group of 138 patients who lived alone and 631 patients who lived with others, while 105 patients were excluded. The patients who lived alone at home stayed one further night in hospital and used more health services. There was no increase in complications or in unanticipated clinical events for the patients who lived alone compared with those who lived with others. There were, in addition, no differences in the functional results or in the improvement in pain, or in the patient's subjective satisfaction, after 90 days.
The authors concluded that patients who live alone had a safe and manageable recovery when they were discharged directly home after total joint replacement surgery. They also concluded that extending the hospital stay and providing more health services to a selected group of patients may reduce the overall financial cost compared with a stay in a rehabilitation centre.
Source: “The Journal of Bone and Joint Surgery”, January 2018
