February 2018

TJA patients discharged home alone do well

In the moment: Rehabilitation

Patients who live alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty (TJA), according to a prospective study published in The Journal of Bone & Joint Surgery.

A majority of institutions routinely discharge patients, especially those living alone, to an inpatient rehabilitation facility following TJA. The rationale is that patients cannot be expected to safely convalesce at home without assistance. The results of this study challenge that standard protocol of admitting these patients to inpatient rehabilitation prior to returning home—a model that reduces medical costs and provides no indication of an increase in the rate of complications.

The prospective study examined 769 patients who underwent primary, unilateral total hip arthroplasty or total knee arthroplasty over an 8-month period. Of this cohort, 138 patients lived alone and 631 patients lived with someone else. Patients living alone more commonly stayed an additional night in the hospital and used more home health services.

No increases in complications or unplanned clinical events were found for patients living alone compared with those living with someone else. Furthermore, no significant differences in functional outcomes or pain relief were detected, and satisfaction scores were equivalent after 90 days. As long as 6 months after surgery, no significant differences were found in scores for joint functioning and quality of life. Nearly 90% of patients living alone said they would choose to be discharged home again. However, patients living alone did report more problems attending to personal hygiene.

Source:

Fleischman AN, Austin MS, Purtill JJ, et al. Patients living alone can be safely discharged directly home after total joint arthroplasty: A prospective cohort study. J Bone Joint Surg Am. 2018;100(2):99-106.

 

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