Shorter hospital stays for arthroplasty patients stirs debate

MedTech & Diagnostics News: Private health insurers in partnership with Australian hospitals and surgeons are piloting shorter hospital stays for arthroplasty patients. This collaborative effort aims to reduce costs for insurers, minimise out-of-pocket expenses for patients, and alleviate strain on the overstretched healthcare system. However, amidst these goals, it becomes essential to scrutinise the impact on patient outcomes and gauge the acceptability of this approach among the patients undergoing treatment.

Orthopaedic surgeon, A/Professor Daevyd Rodda, Sunshine Coast Orthopaedic Group and consultant anaesthetist, Dr Dwane Jackson, conducted a recent study that explored the acceptability of a short-stay care pathway for arthroplasty patients who participated in the Medibank Short-Stay Arthroplasty Program at Vermont Private Hospital (part of the Nexus Hospitals Group), providing valuable insights for health policy, adoption, and scalability of this model of care.

Dr Rodda was the first surgeon to perform joint replacements at Vermont Private Hospital under the ‘Zero Out of Pocket’ initiative.

“Eliminating out of pocket costs for patients is the holy grail for private hospital care. The only way we can ensure no gaps for patients is to have doctors, the private hospital and the private health insurer cooperating to ensure everything is covered,” he said.

The United States has embraced a short-stay approach, allowing patients to be discharged on the same day as their arthroplasty surgery. In contrast, the average length of stay in Australian private hospitals is 4.8 days after total knee replacement (TKR) and 4.9 days after total hip replacement (THR) which is still below the OECD average of 6 days.

According to the study conducted by A/Professor Rodda and Dr Jackson, the key to the success of the short-stay care pathway lies in its flexibility, which patients have hailed as essential. Patients emphasised the importance of adaptability, whether it was adjusting discharge plans, tailoring home services, or providing individualised home-based rehabilitation. The ability of medical staff to collaborate with patients and modify care plans as needed is crucial to the design of effective short-stay care pathways.

Financially, the ‘no gap’ arrangement varied in its influence on acceptability, with some patients considering it essential while others viewed it as an added bonus.

Detailed preoperative information sessions were highly valued by patients, as they felt more informed and experienced reduced anxiety and apprehension. This contrasts with a previous Cochrane review that found limited benefits of preoperative education for THR patients. The tailored approach of the short-stay care pathway’s preoperative education, including both individual and group sessions, seemed to effectively alleviate preoperative anxiety.

Patients’ perception of the effectiveness of the surgery itself, particularly in terms of reduced pain and increased mobility, played a significant role in their acceptance of the short-stay care pathway. This aligns with a similar study on pilonidal sinus surgery, where acceptability was closely linked to positive recovery outcomes. To further enhance acceptability, attention should be given to perceived safety during the early phases of recovery at home. Some patients expressed concerns about the timeliness of postoperative review for potential complications following discharge. While resourceful patients sought help from their general practitioners, this highlights the need for improved postoperative surveillance and intervention to ensure timely and comprehensive care.

Another area for improvement in the acceptability of the short-stay care pathway is holistic preoperative screening. Patients emphasised the importance of adequate support at home to manage their recovery. This included having a capable caregiver or support person to assist with daily activities and provide emotional support.

One aspect that varied among patients and impacted acceptability was their understanding of the ‘short-stay’ component. While patients demonstrated a strong grasp of the arthroplasty procedure itself, their understanding of the shortened hospital stay varied. This uncertainty created concerns about safety and hindered acceptability for some patients. To address these concerns, preoperative information sessions should comprehensively describe the short-stay process, including the expected length of hospital stay, the benefits of recovering at home, and the typical risks associated with longer hospital stays.

Looking towards the future and assuming a 10% participation rate among clinically suitable hip and knee replacement patients in 2023, an estimated 23,000 bed days could be saved across the public and private hospital systems. Expanding the program to include other procedures such as general surgeries, ENT, and cardiology could yield even greater savings. By 2030, the program could save approximately 72,000 bed days, with hip and knee replacements accounting for half of the total. This not only demonstrates the potential for substantial cost savings but also highlights the significant positive impact on healthcare efficiency.

“It’s been 5 years since we started the Medibank Short-Stay Arthroplasty Program at Vermont Private Hospital. I am delighted to announce this program is now available to Medibank customers on the Sunshine Coast,” said Dr Rodda.

There must be a holistic and targeted approach that works in a coordinated fashion to support improved outcomes for the patient, and as a result facilitate an early discharge from hospital.

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