A preoperative education class reduces length of stay for total knee replacement patients identified at risk of an extended length of stay

Abstract

The aim of this study was to compare length of stay in hospital between patients who attended an education class prior to elective total hip or knee replacement surgery, and those who did not attend. A further aim was to establish which patients would benefit most from a preoperative education class, using the Risk Assessment and Predictor Tool. The study showed that patients who attended the class spent 0.38 days less in hospital following hip replacement, and 0.77 days less following knee replacement surgery. Patients undergoing knee replacement who were considered at high risk of an extended hospital stay spent a mean of 2.58 days less in hospital after attending the class. These results support the inclusion of a preoperative education class in this context for both hip and knee replacement procedures, and indicate that this may be most beneficial for patients undergoing knee replacement. Objective: To establish whether attendance at an education class prior to total hip or knee replacement surgery as part of an enhanced recovery after surgery pathway could decrease length of hospital stay. Methods: A single-site, retrospective cohort study comparing length of stay in hospital for patients who attended and did not attend an education class prior to hip or knee replacement surgery. Patients were stratified into 3 groups according to the predicted likelihood of an extended inpatient hospital stay using the Risk Assessment and Predictor Tool. Results: Mean length of stay reduced by 0.37 days for patients who received hip replacement (n = 590) (95% confidence interval (95% CI)-0.74,-0.01, p = 0.05) and by 0.77 days for patients who underwent knee replacement (n = 643) (95% CI-1.23,-0.31, p = 0.001) following attendance at a preoperative education class. Patients undergoing knee replacement who were considered at high risk of an extended hospital stay stayed a mean of 2.59 days less in hospital after attending the class (mean length of stay: 4.52 (standard deviation (SD) 1.26) vs 7.11 (SD 4.18) days (95% CI-4.62,-0.54, p < 0.02). Conclusion: This study supports the inclusion of a preoperative education session in this context for both hip and knee replacement procedures, and indicates that this may be most beneficial for patients undergoing knee replacement who are at risk of an extended length of stay.

Framework, component, and implementation of enhanced recovery pathways

“…The benefits of preoperative patient education extend over clinical, psychological and economic domains [ 10 – 12 ]. It decreases patient anxiety, pain and length of hospital stay following surgery [ 12 ], and also leads to more positive self-image [ 11 ].…”

“…It decreases patient anxiety, pain and length of hospital stay following surgery [ 12 ], and also leads to more positive self-image [ 11 ]. Preoperative education may also improve engagement by making the patient an active participant in their care [ 13 ], and effectively reduces hospitalization duration in patients at high risk of extended stay [ 10 ].…”

Preoperative Education Prior to Hip or Knee Arthroplasty Is Associated With Home Discharge but Not Reduced Length of Stay

“…While hospital length of stay (LOS) has decreased due to factors such as medications, technology, and advancements in procedures, preoperative education has also been shown to decrease hospital LOS [7]. An education session can improve patients’ expectations by providing useful information on the surgical procedure, discharge, rehabilitation, and postoperative care [10,15]. A study by DeMik et al [3] states that a reduction in LOS and an increase in home discharge are likely due to improvements in preoperative optimization and education before elective TJA.…”

Does Participation in Virtual or In-Person Preoperative Education Relate to Reduced Length of Stay After Total Joint Arthroplasty?

“…As an alternative to written educational materials or phone calls, many programs offer preoperative education classes to prepare patients for TJA, aimed at aligning physician and patient expectations for the postoperative period. Frequently, education classes are offered to patients in groups where multiple patients receive the same or similar information all at once [11,13,18,21,27,28,30]. Session content can vary considerably across sites and populations.…”