‘No Place Like Home’ for Older Adults to Recover From Hip Replacement

Longer hospitalization does not mean a safer, faster recovery for patients age 70+

There’s been an overall move toward discharging patients sooner after joint replacement surgery, especially patients ages 40 to 60. However, little has been known about whether this practice is safe for older patients. Now a new study shows that patients in their 70s and 80s who were discharged within one day of having total hip replacement did not have worse outcomes than patients who stayed longer in the hospital.

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“There doesn’t seem to be much benefit to longer hospitalization,” says orthopaedic surgeon Atul Kamath, MD, MBA, Director of the Center for Hip Preservation at Cleveland Clinic. “There’s no place like home, so to speak, when it comes to safety and recovery.”

While some patients with multiple comorbidities should be considered for longer hospital stays, rapid discharge after surgery should be the default, even for these older patients, says Dr. Kamath, senior author of the study published in The Journal of Arthroplasty.

Comparing patients by age

For the retrospective study, researchers used data from the National Surgical Quality Improvement Program database to compare two groups of nearly 2,200 risk-stratified patients: one group that was discharged within one day of surgery and another group that had longer hospital stays. Researchers further separated the groups to compare results of patients in their 70s with those in their 80s.

They found that the two groups had comparable rates of postoperative complications and readmission, a result that was true for patients in their 70s as well as those in their 80s. In addition, rapidly discharged patients were more likely to be sent home rather than to a skilled nursing or rehabilitation facility.

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Dr. Kamath said the results weren’t a surprise.

“I’m seeing it in my own practice,” he says. “I’m seeing older patients leaving the hospital the same day, and I’m also seeing them avoiding rehab facilities.”

He acknowledged that it’s possible that rapid-discharge patients were sent home sooner because they had less complicated surgeries. This group had shorter operating times and fewer bleeding complications overall than the patients who had longer hospital stays, even though they were matched for comorbidities.

“It’s an opportunity for further research,” says Dr. Kamath. “However, the key takeaway should be that staying longer in the hospital does not necessarily mean a safer or faster recovery for older patients undergoing hip replacement.”

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Rapid discharge home is the norm

While younger patients are being discharged sooner, there may be a bias toward keeping older patients in the hospital longer, assuming they are more frail or can’t be sent home safely, notes Dr. Kamath. His study shows that this is not true.

“Older adults not only are able to be discharged sooner, but they are able to go home,” he says.

While rapid discharge home is the norm in his own practice, Dr. Kamath notes that he considers all potential comorbidities before making the determination. Social determinants of health also are factors. For example, if the patient has little support at home or has accessibility issues, Dr. Kamath may recommend recovery at a friend’s house or rehab facility.

“There’s a constellation of risk factors that may preclude it, but the default pathway is discharge home,” he says.