Knee replacement patients to be sent home to recover

Patients who have joint replacement surgery could be routinely discharged from hospital on the same day of their operation as NSW leads the country in instituting shorter stays in hospital.

Patients who receive knee replacements in NSW may soon be discharged from hospital the same day. Picture: istock

Patients who have joint replacement surgery could be routinely discharged from hospital on the same day of their operation as NSW leads the country in instituting shorter stays in hospital.

Knee replacement patients in particular are likely to be offered same-day discharge if they are well enough, after a NSW pilot program found patients recovered well with post-operative in-home support and rehabilitation outcomes were as good or better.

Public hospitals nationwide are buckling under the strain of continually rising elective surgery wait lists as an ageing population and medical workforce challenges place extraordinary strain on the system.

Some private insurers and hospitals have already moved to embrace same-day discharge and at-home rehabilitation for some joint replacement surgeries, with research commissioned by the sector finding no significant difference in the probability of ­having a medical complication between short-stay hospital joint replacement patients and those who stay longer.

The Australian Medical Association recently revealed that as many as half a million patients may now be waiting for planned surgery in public hospitals, taking into account not only ballooning elective surgery wait lists but also the “hidden” waitlists of those waiting for outpatient visits.

The Surgical Care Taskforce established by the Labor government in NSW has been examining outcomes of short-stay patients following elective surgery in public hospitals, hoping to expand the practice in an attempt to take pressure off ballooning surgical wait lists, while at the same time providing optimum care to patients in line with international developments in quicker post-surgery discharge.

The taskforce had examined the results of trials in North America, mirrored by a small trial at Sydney’s Royal North Shore hospital, which indicated between 25 and 40 per cent of patients having certain joint re­placement surgery were suitable for discharge within 24 hours of the operation. Currently, Australians undergoing joint replacements spend on average five days in hospital following their operation – a period of time much higher than many other countries.

Positive results from patients who have been discharged promptly has now led to initiation of the Same Day and Short Stay Joint Replacement Program pilot program in NSW, in which patients will be discharged the day after their surgery when clinically appropriate. All patients involved in the pilot receive comprehensive prehabilitation, or “pre-hab”, which provides support prior to surgery, as well as post-operative in-home care.

It’s hoped the pilot will result in a better patient experience and faster recovery times, while also boosting capacity in hospitals.

NSW Health Minister Ryan Park said governments needed to look for new ways to tackle rising waitlists while providing people with the best care according to modern research.

“People waiting for surgeries longer than clinically recommended are often waiting in pain and discomfort,” Mr Park said.

“We want to reduce overdue surgeries so that people can receive the life-changing treatment they need and enjoy life.

“We want patients to be able to safely recover from the comfort of home, where it is appropriate and safe to do so.

“By doing this, we are boosting the capacity in our busy hospitals, improving patient flow and reducing wait times for others.”