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Written by: Bob Habasevich, PT on Thursday, December 8, 2011 Posted in: Inpatient Rehab

The practice of rehabilitation for total hip joint replacement took another leap into the future by predicting which patients could be released from hospital within two days of surgery.

This Hospital for Special Surgery study will no doubt strengthen arguments that certain patients do not require the intensity of an IRF to optimize functional restoration following total joint replacements.

According to the article, “Fast Track THR: One Hospital’s Experience with a 2-Day Length of Stay Protocol for Total Hip Replacement” appearing in HSS Journal, July 2, 2011, (http://www.springerlink.com/content/hm2179n56t0w708j/fulltext.pdf ) the Fast Track protocol encourages a patient’s earlier and more frequent mobility and activity of daily living. Hospital-based epidural pain relief is stopped earlier and patients are given aspirin to prevent blood clots. In addition, homecare and physical therapy is initiated immediately with discharge.

The average length of stay (LOS) of 2.6 days for the Fast Track group was a third less that compared to traditional patients who average 4.1 or more days LOS post surgery. The study’s authors also evaluated the factors which help predict successful two-day discharges. They found that people without preoperative hypertension and post-operative nausea or dizziness and controlled pain were more likely to receive a two-day discharge.

Gulotta, LV and colleagues conclude: “Since there were no differences in complication, readmission and reoperation rates for the Fast Track group, compared with the Control group in this study, we feel this proves that a two-day discharge, following an uncomplicated total hip replacement in a select group of relatively healthy patients is safe.The program is effective at reducing hospital length of stay.”

Post acute care providers in all settings recognize the trend to admit patients to rehab earlier and more acutely ill than historically admitted.  This is planned and to be expected as the healthcare system attempts to assure the right care at the right time and the right cost. Clinical evidence and analysis will continue to provide answers to the pressing question of what works best in the system’s delivery.

Rehabilitation practices continue to deploy the skills and care required by patients to optimize the restoration of physical and cognitive functions. This work is challenged, not for its effectiveness and need, but the economics associated with its delivery cost.  In the case of the present study, nausea and dizziness were found to be significant barriers to acute discharge and suggest that early management makes possible transfer to rehabilitation resources at lower costs. It is now up to those rehabilitation professionals to validate these perceptions with clinical evidence and outcomes to support proposed practice transformations.

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