After the Hospital, Where Next?

Apr 26, 2018

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After joint replacement surgery, you will likely spend a few days (typically 3 or less) in the hospital. This is so you can be monitored, receive appropriate medical care, receive physical therapy, and recover enough to be safely discharged from the hospital.

Generally speaking, there are two main options of discharge location. You will be discharged to your home or discharged to an inpatient rehab facility. In a rehab facility, you receive intensive therapy (2-3 hours) each day and have the full support of the medical staff including therapists, doctors, nurses, and more. The average stay in a rehab facility is around 10-14 days, but this varies greatly from person to person.

Traditionally, individuals discharged to a rehab facility included people who experienced complications or adverse events in the hospital, people with multiple comorbidities or risk factors, people who had bilateral surgery (both sides) and/or people who lived alone. However, this thinking has evolved due to the results of studies published in recent years.

One study from Australia compared individuals after knee replacement surgery that either spent 10 days at a rehab facility followed by a home-based program or just received a home-based rehab program. They found no significant differences between the two groups in terms of mobility, pain and function, or quality of life at 26-weeks after surgery.

Another study from the American Academy of Orthopedic Surgeons also supports this conclusion. This study from Thomas Jefferson University in Philadelphia, PA, looked at 769 hip and knee replacement patients. 138 of these patients lived alone. The researchers concluded that individuals who were discharged straight home and received outpatient physical therapy recovered just as well as the individuals who were discharged to rehab facilities. This included the individuals who lived alone. They found that there was no increased risk of complications or adverse events with the patients discharged straight home, and also, there was an emotional benefit to recovering in the comfort of one’s own home.

In fact, individuals that spend time in a rehab facility after joint replacement surgery may be more likely to experience complications. One study that looked at adverse events in rehabilitation hospitals noted that “an estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehab hospital stays, resulting in temporary harm; prolonged stays or transfers to other hospitals; permanent harm; life-sustaining intervention; or death” (4). (Of course, it should be noted that individuals that are discharged to rehab facilities likely have more complications and/or risk factors in the first place, compared to individuals that are discharged straight home).

In the majority of cases, it is appropriate to be discharged home from the hospital after hip or knee replacement surgery, even if you live alone. However, inpatient rehab facilities are still a viable option for individuals with complications, decreased function or mobility, or who would not be safe in the home environment. It is beneficial to plan on being discharged home after your surgery. This includes setting up your home environment and making sure you have someone that lives with you or lives nearby to help you, if needed.

References

1. Buhagiar MA, Naylor JM, Harris IA, et al. Effect of inpatient rehabilitation v.s a monitored home-based program on mobility in patients with total knee arthroplasty: The HIHO randomized clinical trial. JAMA. 2017;317(10):1037–1046. doi:10.1001/jama.2017.1224 https://www.ncbi.nlm.nih.gov/pubmed/28291891

2. American Academy of Orthopaedic Surgeons. News release: Even if you live alone, home may be the best place to recover after total joint replacement surgery.2017 Mar 14. http://aaos-annualmeeting-presskit.org/2017/research-news/tjr_home_recovery_hozack/

3. “Time to Rethink Inpatient Rehab After Knee Replacement” Megan Brooks. The Rheumatologist. http://www.the-rheumatologist.org/article/time-rethink-inpatient-rehab-knee-replacement/

4. “Adverse Events in Rehabilitation Hospitals: National Incidence Among Medicare Beneficiaries” Office of Inspector General: U.S. Department of Health and Human Services. https://oig.hhs.gov/oei/reports/oei-06-14-00110.asp

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