A new study questions the belief that patients who live alone should be sent to an inpatient rehabilitation facility after a total joint replacement surgery, before going home.
“Patients living alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty,” write Andrew N. Fleischman, MD, and colleagues from The Rothman Institute, Thomas Jefferson University, Philadelphia, in their study, published recently in The Journal of Bone & Joint Surgery.
In the study, the researchers compared complication rates and other outcomes for patients who lived alone versus those who lived with others, according to a media release from Wolters Kluwer Health: Lippincott Williams and Wilkins.
Among the 769 patients included in the study who were discharged after one-sided total hip or knee replacement, 138 were living alone for the first 2 weeks after surgery. Their average age was 66 (living alone) and 65 (living with others).
About 37% of patients living alone said that they did not have daily or even weekly visitors. However, 79% had someone within 15 minutes away, if needed.
Patients who lived alone were more likely than those not living alone to spend more than 1 night in the hospital: about 21% versus 7% after hip replacement, and 59% versus 28% after knee replacement. Patients living alone also had higher rates of in-home nursing care and physical therapy.
Otherwise, outcomes were similar for patients living alone compared to those who lived with others. In both groups, the overall post-discharge complication rate was about 8%. The two groups also had similar rates of “unplanned clinical events,” such as emergency department or urgent care visits. Pain relief and satisfaction scores during recovery were similar as well.
Up to six months after surgery, there were no significant differences 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, the release continues.
Although some patients who live alone can benefit from home health services or even an extra day in the hospital, discharge directly home may be much more economical than routinely sending them for inpatient rehabilitation—while also avoiding the associated risks, the researchers conclude in the release.
“This prospective study provided evidence to support the safety and efficacy of direct home discharge after total joint arthroplasty for the large majority of patients living alone, justifying this practice as a reasonable standard of routine care,” they write.
[Source(s): Wolters Kluwer Health: Lippincott Williams and Wilkins, Newswise]