Journal of Rehabilitation Medicine 51-10 | Page 68

J Rehabil Med 2019; 51: 788–796 ORIGINAL REPORT A PREOPERATIVE EDUCATION CLASS REDUCES LENGTH OF STAY FOR TOTAL KNEE REPLACEMENT PATIENTS IDENTIFIED AT RISK OF AN EXTENDED LENGTH OF STAY Krisztian SISAK, PhD, FRCS 1 , Ross DARCH, BSc(Hons), MCSP 2 , Louise C. BURGESS, BSc (Hons) 3 , Robert G. MIDDLETON, MA, MBBchir, FRCS(Orth), CCST 2,3 and Thomas W. WAINWRIGHT, PgDip PgCert, BSc(Hons), MCSP 2,3 From the 1 Department of Orthopaedics, University of Szeged, Szeged, Hungary, 2 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, UK and 3 The Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK Objective: To establish whether attendance at an education class prior to total hip or knee replace- ment 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 li- kelihood 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 under- went knee replacement (n  = 643) (95% CI –1.23, –0.31, p  =  0.001) following attendance at a pre- operative 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 in- dicates that this may be most beneficial for patients undergoing knee replacement who are at risk of an extended length of stay. Key words: arthroplasty, replacement, hip; arthroplasty, re- placement, knee; preoperative care; education; enhanced recovery after surgery. Accepted Sep 2, 2019; Epub ahead of print Sep 12, 2019 J Rehabil Med 2019; 51: 788–796 Correspondence address: Thomas Wainwright, Orthopaedic Research Institute, Bournemouth University, 89 Holdenhurst Road, Bourne- mouth, BH8 8EB, UK. E-mail: [email protected] T he volume of total hip and knee replacement sur- geries occurring annually in the United Kingdom (UK) for the treatment of end-stage degenerative joint disease continues to grow linearly with the ageing population (1). The application of enhanced recovery after surgery (ERAS) (also termed fast-track) program- LAY ABSTRACT The aim of this study was to compare length of stay in hospital between patients who attended an educa- tion 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 Assess- ment 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 ex- tended 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 pa- tients undergoing knee replacement. mes, a multidisciplinary approach to patient care (2), combined with the improvement of surgical techniques and better pain management, has improved postope- rative outcomes (3, 4). In addition, the influence that psychological factors may have on recovery from joint replacement surgery has become increasingly recog- nized (5, 6). Patients affected by osteoarthritis may experience worse symptoms in terms of mental health, including anxiety and depression (7, 8). Optimizing the psychological status of patients pre-surgery through education is recommended by the ERAS Society (9); however, current literature is contradictory regarding the effect of preoperative education on length of stay. Although some studies have shown improvement in length of stay with the use of a preoperative education class (10, 11), the majority of the current evidence base does not support the inclusion of routine (non- selective) psychological or educational intervention in total hip or knee replacement pathways (12–15). Orthopaedic surgeons have a pivotal role in transitio- ning the care of their patients from a biomedical to a biopsychosocial model; however, they may not always formally screen patients, and therefore refer for psycho- logical treatment (16). Therefore, it may be that atten- dance at a preoperative education session could improve outcomes for some patients by inducing feelings of control and empowering patients to undertake positive This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2602 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977