Outpatient Patients Happier Than Inpatient?

New research on outpatient arthroplasty has found that patients who go home the day of surgery are just as happy—if not happier—than those patients who remain in the hospital.

The study, “Is Patient Satisfaction Higher with Inpatient or Same Day Total Joint Arthroplasty?” was presented at the recent meeting of the American Academy of Orthopaedic Surgeons.

The study was led by Richard A. Berger, M.D. of Midwest Orthopaedics at Rush, a surgeon who has just performed his 10,000th outpatient joint replacement surgery. The study looked at data from 314 patients undergoing primary hip or knee arthroplasty with the discharge pathway of their choice.

Dr. Berger told OTW, “This is a unique study because all cases were done at Rush, meaning that each patient had the same anesthetist, the same nurses, etc. There was no difference in pre-operative pain, age, gender, marital status, job status, or distance traveled to surgery between the groups.”

“Thus, the only real difference was whether the person left the hospital the same day or spent the night. Our thought was that patients who stay overnight did so in order to allay any fears, etc., and would be substantially happier than the patients who went home the same day.”

“We got a surprise, however,” says Dr. Berger. “The overall satisfaction rate of those who remained in the hospital exceeded 90%, while those who left the same day were just a bit more satisfied. They were just as happy to go home and not use hospital resources. They were instructed on pain control, medications, etc.”

In fact, says Dr. Berger, pain control might go smoother when the person is at home. He told OTW, “At home the medication is at your fingertips. In the hospital if you have pain you press a button, but chances are that you won’t get your medication for 20 minutes because the nurse got sidetracked with an emergency.”

“The educational aspect of this was interesting as well. For example, we asked, ‘Before giving you medication how often did the hospital staff tell you what it was for? We found that 86% of patients staying overnight were very happy or a least satisfied compared to 93% of patients who were discharged the same day.”

“Also, you would think that the longer someone is in the hospital, the more time would be spent on patient education…this was not the case, however. In the often-hectic hospital environment everyone thinks that ‘the other’ nurse already did x, y or z—and they assume that since someone has been in about 24 hours that they are an ‘old pro.’”

“Although outpatient joint replacement seems like a new fad, outpatient hip and knee replacement has been around for quite some time. I have been doing it for18 years. So, if you approach your hospital’s administration and they say, ‘This is new…We’re not sure it is safe’ then you can present them with this and other studies.”