title: Patient evaluation of early discharge after hip arthroplasty: development of a measure and comparison of three centres with differing durations of stay.
abstract: OBJECTIVE
  We compared patients' evaluation of care 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 those of the comparison sites.
  
  
  METHODS
  Cross-sectional cohort study.
  
  
  METHODS
  Consecutive consenting patients undergoing primary hip arthroplasty during 12 months in: a unit that had reduced postoperative stay to median three days; a specialised orthopaedic surgery treatment centre with median stay of five days; a traditional unit with median stay of six days (N = 316, 125, 119, respectively).
  
  
  METHODS
  Six weeks postoperatively, patients completed a specially developed questionnaire measuring their evaluation of care and recovery, together with measures of function and quality of life for validation purposes.
  
  
  RESULTS
  Factor analysis of questionnaire responses identified two independent components of patients' evaluation: problems in staff care and problems in physical recovery. Neither component was impaired in the unit with rapid discharge: similar proportions of patients reported recovery problems in each site (odds radios (ORs) for the two comparators versus unit with rapid discharge: 0.96, 1.18); and more patients reported care problems in the two comparator sites (ORs 2.97, 2.16).
  
  
  CONCLUSIONS
  Duration of stay after primary hip arthroplasty can be reduced to three days without intensive pre- or postoperative care, without detriment to patient evaluation.
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Liverpool L69 3GB, UK. psalmon@liv.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
authors.forename: Gillian R
authors.initials: GR
authors.lastname: Hunt
authors.forename: Burra V S
authors.initials: BV
authors.lastname: Murthy
authors.forename: Seamus
authors.initials: S
authors.lastname: O'Brien
authors.forename: David
authors.initials: D
authors.lastname: Beverland
authors.forename: Martin C
authors.initials: MC
authors.lastname: Lynch
authors.forename: George M
authors.initials: GM
authors.lastname: Hall
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Arthroplasty; length of stay; patient satisfaction; patient-centred outcome measure