The consequences of early discharge after hip arthroplasty for patient outcomes and health care costs: comparison of three centres with differing durations of stay.
OBJECTIVE
To compare outcomes from hip arthroplasty between a surgical unit with a rapid discharge policy and two comparison units to test the hypothesis that the centre with rapid discharge has outcomes that are not inferior to the comparison sites.


METHODS
Prospective cohort study.


METHODS
Consecutive consenting patients receiving primary hip arthroplasty during 12 months beginning July 2006 in three UK National Health Service surgical units. One has shortened postoperative stay to median three days; one was a new treatment centre with median stay of five days; the third was a traditional unit with median stay of six days (N = 316, 119, 87, respectively).


METHODS
Patients were assessed preoperatively and six weeks postoperatively. The primary indicator of function was the Oxford Hip Score. Additional secondary measures included further self-report indicators of function and quality of life and health service costs.


RESULTS
Patient outcome in the unit with rapid discharge was not impaired by comparison with the other sites on any measure: Oxford Hip Score decreased from 49 to 27 in the short-stay unit, from 40 to 30 in the treatment centre and from 43 to 32 in the traditional unit. Cost of arthroplasty was least in the short-stay unit, although there was potential for cost savings in each.


CONCLUSIONS
Short postoperative stay after hip arthroplasty can be achieved without intensive patient preparation or post-discharge care and without compromising short-term patient outcome or increasing health care costs. Longer term follow-up is needed.
Division of Clinical Psychology, University of Liverpool, Liverpool.
Gillian R
GR
Hunt
Grainne
G
Crealey
Burra V S
BV
Murthy
George M
GM
Hall
Philippa
P
Constantine
Seamus
S
O'Brien
Janice
J
Dennison
Pauline
P
Keane
David
D
Beverland
Martin C
MC
Lynch
Peter
P
Salmon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000534:rehabilitation*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function; D055815:Young Adult