Physical Therapy, Same-day Discharge, Total Joint Arthroplasty
Conditions
Brief summary
Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay. In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process. The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.
Interventions
OTHERNovel same-day discharge protocol after total joint arthroplasty
Preoperative gait/stair training with physical therapy, then postoperative ambulation with nursing after total joint arthroplasty
OTHERConventional postoperative physical therapy clearance
Physical therapy evaluation and clearance after total joint arthroplasty
Sponsors
University of Maryland, Baltimore
Hospital for Special Surgery, New York
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* are 18 years of age or older * undergo primary THA or TKA * are eligible for same-day home discharge (friends or family available to stay at home with the patient for one week postoperatively and medically stable for discharge from PACU per anesthesia).
Exclusion criteria
* 90 years of age or older * have sleep apnea (not eligible for same-day discharge) * require overnight stay for any reason * undergo revision THA or TKA.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of postoperative falls per patient | 6 weeks postoperatively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of emergency room visits per patient | 90 days postoperatively | — |
| Number of hospital readmissions per patient | 90 days postoperatively | — |
| Patient satisfaction scores | 6 weeks postoperatively | Surgical Satisfaction Questionnaire-8 (SSQ-8; range 0-100) and numeric satisfaction scale (NSS; range 0-100). Higher scores denote better outcome. |
| Patient reported outcome measure | 6 weeks postoperatively | Knee Injury and Osteoarthritis Outcome Score (KOOS, JR; range 0-100). Higher scores denote better outcome. |
Countries
United States
Outcome results
None listed