HIP-REPLACEMENT AND HIP HEMIARTHROPLASTY SURGERY - POTENTIAL OPPORTUNITIES TO SHORTEN LENGTHS OF HOSPITAL STAY

The potential safety and effectiveness of a practice guideline recomme nding a 5-day postoperative stay in the acute care hospital for hip su rgery patients without clinical findings predictive of a complicated h ospital course was studied retrospectively in 230 patients hospitalize d for total hip replacement, total hip replacement with osteotomy, or hip hemiarthroplasty. Seventy percent of total hip replacement and hip hemiarthroplasty patients were classified as being at ''low risk'' fo r complications by the guideline (161 patients, or 73% of patients who remained hospitalized). Use of the guideline could have reduced the h ospital length of stay from 8.4 days (standard deviation 3.3) to 5.9 d ays for these selected low-risk patients. Moreover, physicians' implic it review determined that 0% of patients (95% confidence interval, 0% to 2.3%) had a complication that would have benefited from continued s tay in an acute care hospital after the fifth postoperative day. Our p ractice guideline may have the potential to safely reduce acute care h ospital length of stay for patients recovering after total hip replace ment and hip hemiarthroplasty. The guideline will require further stud y in a prospective clinical trial before it can be recommended for wid espread use.