Does Time in the Hospital Affect Problems after Hip Replacement?Cost-cutting is just part of health care these days. Insurance companies, hospitals, and doctors are all trying to move patients through the system as quickly as possible. For patients who get total hip replacement (THR) surgery, this means less time in the hospital.
These authors felt like they were seeing more hip dislocations in THR patients soon after surgery. Dislocation after THR can happen when the leg is put in certain positions or does certain movements. Patients get a lot of physical therapy and nursing attention in the hospital after THR. Much of this care involves teaching patients to avoid putting their new hip at risk of dislocating. It is possible that shorter hospital stays resulted in not enough patient education to avoid dislocation.
The study looked at 850 patients who had THR in the 1990s. All patients had THR done in the same North Carolina hospital. All patients had the same type of implant. There were 24 hip dislocations in the first three months after surgery. The rate of hip dislocations was 0.5 percent in the early part of the 1990s. At that time, the average hospital stay was about seven days. Later in the 1990s the average stay was about four days. At that time, the dislocation rate had gone up to almost four percent. This is still a fairly low rate. But the authors were concerned that the dislocation rate went up six times as hospital stays shortened.
Most of the dislocations happened about 20 days after surgery. It is impossible to say whether a longer hospital stay could have prevented these dislocations. Still, it seems clear that shorter hospital stays mean more dislocations after THR. Other studies suggest more problems after knee replacement and some spine surgeries, too. The authors say that their goal was to bring attention to this problem. They call on doctors and hospitals to focus on good patient education to help avoid dislocations after THR.
David R. Mauerhan, MD, et al. Relationship between Length of Stay and Dislocation Rate after Total Hip Arthroplasty. In The Journal of Arthroplasty. December 2003. Vol. 18. No. 8. Pp. 963-967.
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