Whilst the restrictions of the pandemic have left many of us dreaming of the prospect of spending a few nights away from home, a hospital is probably not many people’s first choice of location. However, for those contemplating a hip replacement, a hospital stay is very likely to be on the cards. How long that stay will be is one of the commonest questions people ask before they come in for their operation. The predictable (and boring) answer is that the length of stay in hospital is as long as you need it to be and that will be different for everyone depending on their health, mobility and home circumstances. However, there are measures that can be taken to reduce how long you need to stay in hospital.
In truth, there are relatively few things that need to happen during a stay in hospital for a hip replacement. Clearly, the operation itself is a significant event, but afterwards the control of pain, restoration of mobility and planning for life at home are the other steps and are no less important. Only a decade ago, it was not uncommon for people to spend a week or more in hospital after a hip replacement, a lot of that time lying in bed waiting for things to happen. Nowadays, the average stay in hospital is around three nights, but this is continually reducing. We are now in the situation where increasing numbers of people are having a hip replacement and returning home. Mr Simon Newman has set up this innovative pathway in Oxford for his NHS patients and is now delighted to be able to offer it to his private patients in Central London. Read more about this step change in patient care here: (https://www.ouh.nhs.uk/news/article.aspx?id=1432).
Shorter stays in hospital are appealing to many people and from the perspective of a clinician there is an association between longer hospital stays and increased rates of complications. An association does not equal causation and those staying in hospital longer may have had a complication to keep them in hospital. However, prolonged time in bed increases the risk of deep vein thrombosis and a study last year looking at rates of Covid transmission during inpatient stays for hip and knee replacement suggested that the risk of catching the virus increased following three or more days in hospital (https://pubmed.ncbi.nlm.nih.gov/33591211/). So, increased mobility and shorter hospital stays are almost certainly a good thing.
Improvements in surgical technique have played a part in the reduction in length of stay with more minimally invasive surgical approaches, better control of blood loss and the use of more stable implants all helping. However, it takes more than just having a “good” operation to get home promptly. All the members of the healthcare team have a significant impact on how quickly discharge occurs. An anaesthetic that results in prolonged immobilisation will prevent getting out of bed on the day of the operation. The use of post-operative pain medication that makes you feel sick will also confine you to bed. If there is no physiotherapist available when you are ready to start walking or your discharge medications are not available from the pharmacy it will result in a longer stay in the hospital.
For various reasons, some people may prefer a longer stay in hospital. For those who would prefer to shorten their stay, these are the issues to consider:
- Have someone with you at home for the first few days after surgery. If they don’t live with you normally, if possible, ask them to be flexible about when you are likely to be returning home rather than fixing a date “x” days after the operation.
- Speak to your physio before the operation. Practice with crutches at home before the procedure – including on stairs if you have them. Also, make sure that your physio will be available to see you on the day of the operation.
- Get advice from an occupational therapist about any equipment you might need and obtain it before you come in for your procedure.
- Talk to your anaesthetist about having an anaesthetic that will allow you to mobilise on the day of the operation. Ask them if you are suitable for higher doses of the medication dexamethasone at the time of surgery – this steroid helps reduce pain and nausea after surgery and has been associated with helping get people home faster after hip replacement.
- Ask your surgeon if their recommended painkiller regime minimises the use of opiate (morphine/codeine) medications as these can make you feel sick and cause constipation.
If you are a physio who would like further information about enhanced recovery from hip replacement, or a patient looking to receive the latest in orthopaedic care please get in contact on 0203 526 9615.
Find out more about Mr Simon Newman here: