Changing Patient Expectations Decreases Length of Stay In Rapid Recovery Total Hip Arthroplasty (THA)

Care pathways in THA rapid recovery (RR) programs have been shown to result in a significant decrease in length of stay (LOS). This study demonstrated that changing the patient’s expectation regarding their discharge, without changing the rest of the RR care pathway would result in a meaningful change in LOS.

We retrospectively compared the LOS in 100 consecutive THA patients following the implementation of a 4-day RR care pathway (Group 1) with 100 consecutive patients who were also in the same pathway, but were told by their surgeon preoperatively and in-hospital to expect a LOS of only 2 days (Group 2). Aside from the re-education by the surgeon, there was no difference in the surgery, intraoperative or postoperative management of the 2 groups. Only the patient and the surgeon were made aware of the accelerated discharge plan. All patients had a mini posterior approach with a cementless THA. We compared the LOS between the 2 groups and the number of patients that met their discharge goal.

All patients were discharged home after surgery. Overall, the mean LOS was 4 days in Group 1 with 82% of the patients discharged within 4 days. The mean LOS in Group 2 was only 3 days with 94% of the patients discharged within 4 days. In Group 2, the LOS was 2 days in 32% compared to 8% in Group 1. The LOS was 3 days in 51% of patients in Group 2 and 39% of the patients in Group 1. Patients under 50 years of age were more likely to have a shorter LOS. In patients 80 years or older, the mean LOS decreased from 5 days in Group 1 to 3 days in Group 2. There were no readmissions in either group.

The aim of an RR care pathway program for THA is to standardize peri-operative care in order to reduce length of stay LOS and to promote rapid recovery postoperatively. A successful RR pathway incorporates many factors with the combined effect of reducing LOS. This study evaluated the contribution of only the patient expectations in the reduction in LOS. We found that LOS after primary THA can be significantly reduced by changing the patient`s expectations. Patient expectations of LOS alone, led to a mean decrease of 1 day in LOS. This study highlights the significant influence patient education and expectations have on the effectiveness of RR care pathways in THA as well as the importance of continuous reinforcement of discharge planning both preoperatively and in-hospital.