Abstract
Background Recent evidence suggests benefit to receiving physical therapy (PT) the same day as total joint arthroplasty (TJA), but relatively little is known about barriers to providing PT in this constrained time period. We address the following questions: (1) Are there demographic or perioperative variables associated with receiving delayed PT following TJA? (2) Does receiving immediate PT following TJA affect short-term outcomes such as length of stay, discharge disposition, or 30-day readmission? Methods. Primary TJA procedures at a single center were retrospectively reviewed. Immediate PT was defined as within eight hours of surgery. Demographic and perioperative variables were compared between patients who received immediate PT and those who did not. We identified an appropriately matched control group of patients who received immediate PT. Postoperative length of stay, discharge disposition, and 30-day readmissions were compared between matched groups. Results In total, 2051 primary TJA procedures were reviewed. Of these, 226 (11.0%) received delayed PT. These patients had a higher rate of general anesthesia (25.2% versus 17.8%, p=0.006), later operative start time (13:26 [11:31-14:38] versus 9:36 [8:24-11:16], p<0.001), longer operative time (1.8 [1.5-2.2] versus 1.6 [1.4-1.8] hours, p=0.002), and higher overall caseload on the day of surgery (6 [4-9] versus 5 [4-8], p=0.002). A matched group of patients who received immediate PT was identified. There were no differences in postoperative length of stay or discharge disposition between matched immediate and delayed PT groups, but delayed PT (OR 4.54; 95% CI 1.61-12.84; p=0.004) was associated with a higher 30-day readmission rate. ConclusionBarriers to receiving immediate PT following TJA included general anesthesia, later operative start time, longer operative time, and higher daily caseload. These factors present potential targets for improving the delivery of immediate postoperative PT. Early PT may help reduce 30-day readmissions, but additional research is necessary to further characterize this relationship.
Highlights
Total joint arthroplasty (TJA) is a highly successful surgical intervention, providing significant improvements in physical function and quality of life [1]
We address the following questions: (1) Are there demographic or perioperative variables associated with receiving delayed physical therapy (PT) following total joint arthroplasty (TJA)? (2) Does receiving immediate PT following TJA affect short-term outcomes such as length of stay, discharge disposition, or 30-day readmission?
2051 primary TJA procedures were performed at our institution from July 2015 to December 2017
Summary
Total joint arthroplasty (TJA) is a highly successful surgical intervention, providing significant improvements in physical function and quality of life [1]. 80% of patients who did not receive PT on the same day as surgery had an operative end time before 15:00, suggesting that there are additional factors at play Identifying these barriers could hold implications for improving the delivery of early PT following TJA. There were no differences in postoperative length of stay or discharge disposition between matched immediate and delayed PT groups, but delayed PT (OR 4.54; 95% CI 1.61-12.84; p=0.004) was associated with a higher 30-day readmission rate. Barriers to receiving immediate PT following TJA included general anesthesia, later operative start time, longer operative time, and higher daily caseload. These factors present potential targets for improving the delivery of immediate postoperative PT. PT may help reduce 30-day readmissions, but additional research is necessary to further characterize this relationship
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