Patients Who Live Alone Can Safely Recover at Home after TJA
A study recently published in The Journal of Bone & Joint Surgery suggests that most patients who live alone can be safely discharged home from the hospital to recover from total joint arthroplasty (TJA).
The results question the belief that patients who live alone should routinely be sent to an inpatient rehabilitation facility after TJA, before going home. “Patients living alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty,” according to the authors, who are from The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
The study included 769 patients who were discharged home after unilateral total hip or knee replacement. Of these, 138 patients were living alone for the first 2 weeks after surgery. The researchers compared complication rates and other important outcomes for patients who lived alone versus those who lived with others.
Average age (about 66 years for patients living alone and 65 for those living with others) and other preoperative characteristics were similar between groups. Approximately 37% of patients living alone said that they did not have daily or even weekly visitors. However, 79% had someone who lived within 15 minutes of their home if needed.
Patients who lived alone were more likely than those not living alone to spend more than 1 night in the hospital: 21% versus 7% after hip replacement and 59% versus 28% after knee replacement. Patients living alone also had higher rates of in-home nursing care and physical therapy.
Otherwise, outcomes were similar for patients living alone compared to those who lived with others. In both groups, the overall post-discharge complication rate was approximately 8%. The 2 groups also had similar rates of “unplanned clinical events,” such as emergency department or urgent care visits. Pain relief and satisfaction scores during recovery were similar as well.
No significant differences were seen in scores for joint functioning and quality of life up to 6 months after surgery. Nearly 90% of patients living alone said they would choose to be discharged home again. However, patients living alone did report more problems attending to personal hygiene.
The authors concluded that, “This prospective study provide[s] evidence to support the safety and efficacy of direct home discharge after total joint arthroplasty for the large majority of patients living alone, justifying this practice as a reasonable standard of routine care.”
Fleischman A, Austin MS, Purtill JJ, Parvizi J, Hozack WJ. Patients living alone can be safely discharged directly home after total joint arthroplasty: a prospective cohort study. J Bone Joint Surg Am 2018 Jan 17;100(2):99-106.
The authors have no disclosures relevant to this study.