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