Journal of Rehabilitation Medicine 51-10 | Page 70

790
K. Sisak et al.
Table I. Characteristics and length of stay for patients who
underwent total hip and knee replacement between 27 July 2010
and 04 November 2011
All
(n  = 1,233)
Attended education class
Patients, n (%)
Age, years, mean (SD)
Sex, female/male, n
Length of stay, days, mean (SD)
RAPT score, mean (SD)
Did not attend education class
Patients, n (%)
Age, years, mean (SD)
Sex (female/male), n
Length of stay, days, mean (SD)
RAPT score, mean (SD)
Total hip
replacement
(n  = 590) Total knee
replacement
(n  = 643)
497 (84.2)
69.87 (9.69)
324/173
4.00 (1.27)
8.72 (2.10) 521 (81)
70.90 (8.22)
305/216
4.14 (1.37
8.84 (1.97)
93 (15.8)
70.96 (10.63)
59/34
4.37 (1.74)
8.26 (2.50 122 (19)
72.15 (8.73)
76/46
4.91 (2.49)
8.33 (2.18)
RAPT: Risk Assessment and Predictor Tool; SD: standard deviation.
tend the pre-operative group, based on 3 sub-categories for each
group of RAPT (red, amber and green), were compared using
the Kruskal–Wallis test to establish if the score was evenly
distributed. A p-value of 0.36 showed that the samples came
from the same population. All data were analysed at a level of
statistical significance of 0.05 and a power of 0.95.
RESULTS
Table I presents mean data from 1,233 patients with
elective total hip or knee replacement, sourced from
the hospital database. A total of 1,018 patients (82.5%)
attended their preoperative education session (hip re-
placement: 497 (84.2%), knee replacement: 521 (81%))
and 215 (17.5%) did not attend (hip replacement: 93
(15.8%), knee replacement: 122 (19%)). The mean time
between the education class and surgery was 7.1 days
(range 2–21 days). Mean length of stay was reduced
by 0.37 days for patients who had received total hip
replacement surgery (95% CI –0.74, –0.01, p = 0.05) and
by 0.77 days for patients who had undergone total knee
replacement (95% CI –1.23, –0.31, p = 0.001) following
attendance at a 1-h preoperative education class.
Total hip replacement
There were no statistically significant differences in
mean length of stay between patients undergoing hip
replacement who did and did not attend their preope-
rative education class when data were categorized into
red, amber and green RAPT scores (Table II).
Total knee replacement
Patients who received total knee replacement with a
red RAPT score and attended the preoperative educa-
tion class stayed a mean of 2.59 days less in hospital
than those who did not attend (mean length of stay
4.52 (SD 1.26) vs 7.11 days (SD 4.18) (95% CI –4.62,
–0.54, p < 0.02). Patients with an amber RAPT score
who attended the preoperative education class stayed
0.56 days less in hospital than those who did not at-
tend (mean length of stay 4.34 (SD 1.46) vs 4.90 days
(SD 1.99) (95% CI –1.10, –0.03, p < 0.04). However,
there were no significant differences between patients
who attended and did not attend the class with a green
RAPT score (Table II).
DISCUSSION
This retrospective analysis demonstrates a general re-
duction in mean length of stay for patients undergoing
total hip and knee replacement surgery who attended a
preoperative education class, compared with those who
did not. The benefits were greatest for patients presen-
ting with a high or medium risk of needing extended
inpatient rehabilitation, as classified by RAPT score,
and were more clinically significant for patients at high
risk and who received knee replacement surgery. Other
factors previously reported to contribute to differences
in length of stay are: age, use of preoperative walking
aid, anaemia, diabetes, hypertension, use of anticoa-
gulants, cardiopulmonary disease, and psychiatric
disease (24–27).
The results of the current study are similar to those
of Yoon et al. (10), whereby patients who attended an
education session experienced a significantly shorter
length of stay than non-participants for both total
hip replacement (3.1 (SD 0.9) vs 3.9 days (SD 1.4);
p = 0.001) and total knee replacement (3.1 (SD 0.9) vs
4.1 days (SD 1.9); p = 0.001). However, Yoon et al.’s
Table II. Attendance at class, mean length of stay and RAPT scores for hip and knee replacement
Red RAPT
Amber RAPT
LOS, days,
Difference in
mean
Age, years, LOS
n (%) (SD)
mean (SD) (95% CI)
n (%)
Green RAPT
LOS, days,
Difference in
mean
Age, years, LOS
(SD)
mean (SD) (95% CI)
n (%)
LOS, days, Age, years Difference
mean
, mean
in LOS
(SD)
(SD)
(95% CI)
Total hip replacement patients
Attended 40 (74) 5.35 (2.06) 78.75 (8.28) 0.06
DNA
14 (26) 5.29 (1.81) 80.79 (3.60) (–1.18, 1.31) 249 (84) 4.12 (1.17) 73.2 (8.22
46 (16) 4.65 (2.01) 74.13 (8.95
Total knee replacement patients
Attended 46 (71) 4.52 (1.26) 77.43 (5.48) –2.58 249 (80) 4.34 (1.46) 73.63 (7.66) –0.57
DNA
19 (29) 7.1 (4.18)
79.47 (7.52) (–4.62, –0.54) 62 (20)
4.9 (1.99)
–0.53
(–1.15, 0.08)
3.59 (0.93) 64.18 (8.36) 0.08
(–0.26, 0.41)
3.52 (0.71) 62.36
226 (84.5) 3.85 (1.24) 66.59 (7.05) –0.05
(–0.46, 0.36)
3.9 (1.22) 65.54 (6.29)
74.27 (7.61) (–1.10, –0.03) 41 (15.5)
RAPT: Risk Assessment and Predictor Tool; SD: standard deviation; DNA; did not attend; LOS: length of stay.
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208 (86)
33 (14)