Study Finds Outpatient Joint Replacement Surgery Makes for Happier Patients

A new study found that joint replacement patients who go home the day of surgery are as happy—if not happier—than those who remain in the hospital. The study, “Is Patient Satisfaction Higher with Inpatient or Same Day Total Joint Arthroplasty?” involved 181 patients who were discharged home on the day of surgery and 106 who stayed in the hospital one night.  The study was presented at the recent meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Las Vegas, Nevada.

This is the first study to examine patient satisfaction when all patients are given a choice between same-day discharge from the hospital and being admitted for a one-night stay in the hospital. It was led by Richard Berger, M.D., an orthopedic surgeon at Midwest Orthopaedics at Rush who has performed more outpatient joint replacement surgeries than any other physician in the country, with a team including: Chris Culvern, M.S., Director of Research for Joint Replacement, Rush University Medical Center;  Gregory Manista, M.D, Clinical Research Coordinator at Midwest Orthopaedics at Rush; and orthopedic fellow trainees Vasili Karas, M.D. and Linda Suleiman, M.D.

Each patient in the study had the same surgeon, hospital, anesthetist, and nurse. The only difference was whether the person decided to go home on the day of surgery or chose to stay overnight in the hospital.  The groups were monitored for pre-operative pain, age, gender, marital status, job status, or distance traveled to surgery.

And while the researchers anticipated that patients choosing to remain in the hospital overnight would be happier than those who went home the same day, they instead found that the overall satisfaction rate of those who chose to leave the same day exceeded those who remained in the hospital.  There was an over 90 percent satisfaction rate for those who stayed in the hospital – and those who went home the day of surgery had an even higher satisfaction rate.  

Dr. Berger notes, “I am not surprised by these findings. I have performed more than 10,000 outpatient joint replacements with not only enormous clinical success but these patients have been even happier by returning to the comfort of their own home the same day.”

This research shows that the decision to undergo outpatient versus inpatient joint replacement, while made in collaboration with the surgeon, is largely driven by patient preference. 

One of Dr. Berger’s patient’s, Judy Ryan of Burr Ridge, Illinois, has undergone four outpatient joint replacements. “It was a relief and a pleasure to walk out of the surgery center on my own,” she says. “Not to mention that I enjoyed sleeping in my own bed that first night. I also recuperated much faster than my friends who chose to stay overnight in the hospital. I was playing golf three weeks after hip surgery and six weeks after knee surgery.”

The ‘same day’ patients were especially happy with the pain management protocol and communication about medications. Dr. Berger: “When we asked, ‘Before giving you medication, how often did the hospital staff tell you what it was for?’ we found that 93% of patients who were discharged the same day were very happy with the pain management process.”

The hospital environment may contain some answers to related issues, says Dr. Berger. “We have a fantastic hospital. In fact, it is ranked no 4 in the country for orthopedics. The hospital is a great place to be if you are sick or if you are dealing with chronic health conditions or are a high-risk patient. I find that most of my joint replacement patients are happier recovering in their own home.” 

“The fundamental lesson here,” says Dr. Berger, “is that when you allow patients to make their own decisions about their treatment and recovery, they are more satisfied.”