gms | German Medical Science

Objectives: Reduction of length of stay (LOS) without compromising quality of care is a trend observed in several orthopaedic departments. To achieve this goal the whole pathway needs to be optimised including patient education, effective multimodal pain management, accelerated rehabilitation and monitoring for safety and outcomes. This requires team work than can be supported by e-health solutions. The objective of this retrospective observational study was to assess the impact of reduction in LOS on complications and readmissions in one hospital where accelerated discharge was introduced due to the pandemic.

Methods: 317 patients with primary total hip and total knee replacements treated in the same hospital between October 2018 and February 2021 were included.

Only elective surgery patients are included in this health trajectory. The patients were divided in two groups: the pre-pandemic group and the pandemic group.

The discharge criteria for both groups were: patient feels comfortable with going back home, patient has enough support at home, no wound leakage, independence in activities of daily living, independent mobility (walking possible with walking aids).

No face-to-face surgeon or nurse follow-up was planned. Patients' progress was monitored via the mobile application. The patients received information regularly about their recovery status, as well as important education materials, postoperative exercises and a coaching via secure chat.

The length of stay (LOS) and complications were assessed through questions in the app and patients filled in standard PROMs preoperatively, at 6 weeks and 3 months.

Results and conclusion: Before the pandemic, 64.8% of the patients spent 3 nights at hospital. During the pandemic, 52.0% of the patients spent only 1 night in hospital. The median value changed from 3 days (interquartile space 3-4) to 1 day (interquartile space 1-2). The complication rate before the pandemic of 15% dropped to 9 % during the pandemic. The readmission rate remained stable with 4% before the pandemic and 5 % during the pandemic. Overall, 41 complications and 15 readmissions were observed for the 317 patients. The most frequent complications before the pandemic were severe pain, wound complications, infection and, stiffness while the most frequent complication during the pandemic were dislocation, wound complication and extensor mechanism disruption. No difference were observed for difference in PROMS between 3 months and before surgery.

The results of this study showed that after a hip and knee surgery, the shortening of the LOS with adequate discharge criteria from three to one night resulted in less complications and a stable rate of readmissions. These results are in line with literature data on enhanced recovery after hip and knee arthroplasty. The concept used in this study is transferable to other hospitals, and may have economic implications through reduced hospital costs.