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Formal Physical Therapy Clearance Is Not Necessary for Safe Home Discharge After Primary Total Joint Arthroplasty: A
Brooke Merchant1, Jaime Harris2, David Sproul2
1Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
Background:
Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge. We developed a novel TJA discharge protocol without PT clearance. We aimed to determine if our novel protocol: (1) allows safe home discharge; and (2) preserves patient-reported outcome measures (PROMs).
Methods:
A billing database was queried for primary TJA from 2020 to 2023 (n = 501). Study cohorts were per discharge protocol, conventional (n = 359) or novel (n = 142). The primary end point was 30-day falls. The secondary end points were emergency room visits, readmissions, and reoperations within 90 days, as well as same-day discharge. The PROMs were recorded 6 weeks postoperatively. Multivariate regressions were used to assess associations between discharge protocol and study end points or outcomes.
Results:
There was no difference in 30-day falls between novel (2.8%) and conventional (2.2%) discharge protocols (odds ratio [OR] 1.50, 95% confidence interval [CI] 0.50 to 4.53, P = 0.47). The 90-day emergency room visits (14.1% novel, 12.5% conventional; OR 1.22, 95% CI 0.68 to 2.18, P = 0.50), readmissions (3.5% novel, 2.2% conventional; OR 2.06, 95% CI 0.73 to 5.81, P = 0.17), and reoperations (0.7% novel, 0.8% conventional; OR 1.09, 95% CI 0.23 to 5.12, P = 0.91) did not differ between protocols. Same-day discharge was more likely (OR 3.19, 95% CI 1.94 to 5.24, P < 0.0001) with novel protocol (64.1%) than standard protocol (44.0%). We did not find differences in 6-week Patient-Reported Outcomes Measurement Information System Physical Function (P = 0.76) or Surgical Satisfaction Questionnaire (P = 0.51) between protocols.
Conclusions:
Our novel primary TJA discharge protocol without postoperative PT clearance maximizes safe day-of-surgery discharge while maintaining patient function and satisfaction. Thus, risks of longer lengths of stay and costs of hospital occupancy are minimized.
Level Of Evidence:
Therapeutic Level III.
