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What Doctors Don't Tell You

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January 2020 (Vol. 11 Issue 4)

Same-day hospital release after hip op 'dangerous'
About the author: 
Bryan Hubbard

Same-day hospital release after hip op 'dangerous' image

Orthopaedic surgeons can be keen to get the patient out of the hospital even on the same day of total hip or knee replacement surgery—but it's a dangerous practice that doubles the chances of lung or heart complications.

Even staying in the hospital overnight dramatically reduces the risk of serious complications, say researchers from the Weill Medical College at Cornell University.

Patients who leave the hospital the day of the procedure are nearly twice as likely to suffer serious cardiac or pulmonary complications inside the first 30 days, and often within the first few days—and in some cases, the risk was nearly four times greater than it was in those who stayed in the hospital overnight. The risk was slightly higher among patients who had undergone total hip arthroplasty (replacement or rebuilding).

The practice of same-day discharge goes against traditional best practice guidelines but has become increasingly common in the past decade because of financial restraints along with improving surgical procedures and better rehabilitation care.

In 2018, total knee replacement surgery became a same-day procedure, and hip replacement is expected to be similarly recognised by the Centre for Medicare and Medicaid Service (CMS) very soon.

But the practise is not as safe as earlier studies had found. Of the 226,000 knee replacement procedures tracked by the researchers, 3,118 had been sent home the same day, as had 2,600 of the 140,000 patients given a new hip—and they were twice as likely to suffer complications.

With the number of annual knee procedures projected to reach 3.48 million and hip procedures 700,000 in the US by 2030, recognising the dangers of same-day discharge will become imperative, the researchers say.

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References

(Source: BMJ Open, 2019; e031260)

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