Can We Reduce the Utilization of Home-Visiting Nurse Services After Primary Total Joint Arthroplasty?
Home-visiting nurse services (HVNSs) after total joint arthroplasty (TJA) are touted as advantageous compared with inpatient rehabilitation. No study has established the utility of HVNSs compared with discharge home without services.



A retrospective single-surgeon consecutive series of 509 primary TJA patients compared discharge disposition, length of stay, complications, and patient satisfaction between 2 cohorts. The cohorts were defined by the elimination of routine HVNSs.



Surprisingly, without routine HVNSs, more patients were discharged home (95% vs 88.3% with routine HVNSs) and mean length of stay significantly decreased. Complication rate was similar (2.9% vs 3.9% with routine HVNSs). Patient satisfaction remained favorable. We estimated that eliminating HVNSs avoids excess costs of $1177 per hip and $1647 per knee arthroplasty.



With dramatically diminished HVNS utilization after primary TJA, there was an associated decrease in length of stay and no increase in complication rate suggesting no compromise of patient care with significant cost savings.
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Danielle Y
DY
Ponzio
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Andrew G
AG
Park
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Suneel B
SB
Bhat
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
James J
JJ
Purtill
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D017046:Cost Savings; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D064691:Nurses, Community Health / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D005791:Patient Care; D010351:Patient Discharge; D010359:Patient Readmission; D017060:Patient Satisfaction; D012046:Rehabilitation; D012189:Retrospective Studies; D013269:Stochastic Processes; D016896:Treatment Outcome
discharge disposition; home-visiting nurse services; post–acute care; rehabilitation; total joint arthroplasty