Preoperative Education Program Research Articles

The Effects of a Standardized Preoperative Education Program on Stomach Cancer Patients undergoing Gastrectomy

Purpose: The purpose of this study was to identify the effects of a standardized preoperative education program on self-care knowledge, performance, satisfaction, and physical recovery in the stomach cancer patients undergoing gastrectomy. Methods: A nonequivalent control group non-synchronized design was utilized and 63 participants who underwent gastrectomy (31 for experimental group, 32 for control group) were recruited at a university hospital from May to August 2015. Results: There were significant differences between the groups in self-care knowledge (F=17.63, p＜.001), performance (F=-9.25, p＜.001) and satisfaction (F=-6.91, p＜.001). Although the pain levels (F=974.57, p＜.001) showed significant differences in each group and 3 time intervals (F=18.26, p＜.001), there was no interaction of group and time (F=0.09, p=.917). The highest body temperature at 48 hours after surgery (F=1.32, p=.192), as well as presence of atelectasis (F=2.23, p=.213) indicating a chance of pulmonary complications, and the time of first gas pass (F=-1.05, p=.299), presence of paralytic ileus (F=0.13, p=.719) were not significantly differ. Conclusion: The preoperative education program developed in this study can be utilized as a part of nursing interventions and be beneficial to patients who undergo stomach cancer surgery for their thorough understanding.

Clinical and Cost Implications of Inpatient Versus Outpatient Orthopedic Surgeries: A Systematic Review of the Published Literature.

The number of outpatient orthopedic surgeries performed within North America continues to increase. The impact of this change in services on patient outcomes is largely unknown. The objective of this review is to compare patient outcomes and associated costs for outpatient orthopedic surgeries traditionally performed in hospital to inpatient surgeries, as well as to summarize the eligibility and preoperative education requirements for outpatient orthopedic surgery in North America. We performed a systematic review of Medline, Pubmed and Embase databases for articles comparing the clinical and economic impact of outpatient orthopedic surgical procedures versus inpatient procedures in North America. We reported on requirements for inpatient versus outpatient care, preoperative education requirements, complications and patient outcomes, patient satisfaction, and when available total mean costs. Nine studies met the inclusion criteria for this review. Eligibility requirements for outpatient orthopedic surgery within the included studies varied, but generally included: patient consent, a caregiver at home following surgery, close proximity to an outpatient center, and no history of serious medical problems. Preoperative education programs were not always compulsory and practices varied between outpatient centers. All of the reviewed studies reported that outpatient surgeries had similar or improved level of pain and rates of nausea. Outpatients reported increased satisfaction with the care they received. As expected, outpatient procedures were less expensive than inpatient procedures. This review found that outpatient procedures in North America appear to be less expensive and safe alternatives to inpatient care for patients who are at lower risk for complications and procedures that do not necessarily require close hospital level care monitoring following same day surgery.

Development of the knee osteoarthritis patient education questionnaire: a new measure for evaluating preoperative patient education programmes for patients undergoing total knee replacement.

The aim of this study was to develop a generic instrument for the use of patients, named the Knee Osteoarthrtis Patient Education Questionnaire (KOPEQ), to assess the validity of a preoperative educational intervention and to make a preliminary test of its psychometric properties. A patient-reported outcome instrument was designed, using the conceptual framework of Wilson and Cleary as a methodological guide. Likert items with a five-point scale were chosen for the scoring option. The feasibility and interpretability of administering the KOPEQ was tested through conducting interviews with targeted patients. Items of the KOPEQ were linked to the International Classification of Functioning, Disability and Health (ICF). Psychometric testing contained internal consistency for reliability, and factor analysis for validity properties. A final list of 16 items was derived and linked to the ICF. Targeted patients confirmed in interviews, that all 16 questions were highly understandable and that the length of the questionnaire was feasible and acceptable. There was a good internal consistency for the 16-item KOPEQ with a Cronbach's alpha of 0.83 (95% confidence interval 0.71-0.94). Sixty-one percent of the variance was explained by a four-factor model and the factors were named "didactics", "addressability", "empowerment" and "theory". Results of a factor analysis provided a loading of the separate items between 0.469 and 0.958. The KOPEQ can help to provide health professionals with reliable feedback on how patients assessed the applied patient education intervention. Interviews with patients and a factor analysis revealed new and important insight.

The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol.

The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings. Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education. While Johansson et al. included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013.Kruzik also reported benefits of decreased length of stay, reduced pain medication requested post-operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.Types of education involved in this systematic review are patient education, pre-operative education, and discharge education. Only one study discussed discharge education and the outcome from this review. The outcomes that have been discussed in this systematic review include length of stay, satisfaction, pain level,, 21 cost of care, functional abilities, knowledge, anxiety, and quality of life.Major outcomes discussed in these studies are length of stay, pain,, 21 functional abilities, and anxiety. Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement. A study on spinal surgery patients and the effects of pre-operative education, which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain.This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.

The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series.

Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS.

Development of a Preoperative Neuroscience Educational Program for Patients with Lumbar Radiculopathy

Postoperative rehabilitation for lumbar radiculopathy has shown little effect on reducing pain and disability. Current preoperative education programs with a focus on a biomedical approach feature procedural and anatomical information, and these too have shown little effect on postoperative outcomes. This report describes the development of an evidence-based educational program and booklet for patients undergoing lumbar surgery for radiculopathy using a recently conducted systematic review of neuroscience education for musculoskeletal pain. The previous systematic review produced evidence for neuroscience education as well as best-evidence synthesis of the content and delivery methods for neuroscience education for musculoskeletal pain. These evidence statements were extracted and developed into patient-centered messages and a booklet, which was then evaluated by peer and patient review. The neuroscience educational booklet and preoperative program convey key messages from the previous systematic review aimed at reducing fear and anxiety before surgery and assist in developing realistic expectations regarding pain after surgery. Key topics include the decision to undergo surgery, pain processing, peripheral nerve sensitization, effect of anxiety and stress on pain, surgery and the nervous system, and decreasing nerve sensitization. Feedback from the evaluations of the booklet and preoperative program was favorable from all review groups, suggesting that this proposed evidence-based neuroscience educational program may be ready for clinical application.

Gender Differences in Questions Asked in an Online Preoperative Patient Education Program

Although osteoarthritis more commonly affects women than men, women are 3 times less likely to undergo hip or knee replacement surgery compared with men. Disparity in the appropriate utilization of surgery between men and women is a complex subject that must take into account the willingness of a patient to proceed with the operation. Adequately addressing patient concerns before surgery may influence such willingness. We examined if a gender difference can be identified in the frequency and types of questions submitted by patients scheduled for total hip or total knee arthroplasty. Patients completed an online interactive preoperative educational program and a database was created containing deidentified information on surgical procedure, sex, year of birth, and any questions that were submitted. Data were also available regarding the total number of patients issued the program, the number of patients who started the program, and the number of patients who completed the program. The results were analyzed by Wilcoxon rank sum test. P values ≤0.05 were considered statistically significant. Among the 2770 women and 1708 men included in the study, 935 (34%) and 462 (27%) asked at least 1 question, respectively. Compared with men, women asked a significantly greater number of questions overall (P < 0.001). Women also asked a significantly greater number of questions in the categories Your Condition (P = 0.031), Your Procedure (P < 0.001), and Risks and Benefits (P < 0.001). Gender differences in concerns and physicians' ability to adequately address these concerns may contribute to disparity in use of hip and knee replacement surgery between men and women. Effective preoperative counseling for women may require additional resources to address their higher level of questions.

Effects of a web-based preoperative education program for patients undergoing ambulatory surgery: a preliminary study

Increasing numbers of surgical procedures that were once done in hospitals are now being performed in ambulatory care settings. Provision of quality preoperative education in those settings has become a challenge. This article reports findings from a practice-based study where the nurses in a preoperative preparation center implemented a supplemental, web-based educational program for same-day surgery patients and assessed its outcomes (N = 69). The patients who used the web-based program in addition to usual care achieved significantly higher scores for anesthesia knowledge (t = 2.15, p = 0.04) and teaching satisfaction (t = 2.13, p = 0.04) than those who received usual care only. The findings demonstrate a great potential for use of web-based programs to improve patient education in busy preoperative care areas. A convenience sample with a small sample size was a major limitation. Further studies with large samples are needed to demonstrate tangible clinical outcomes.

Intérêt d’un programme préopératoire simplifié de rééducation à domicile sur la durée de séjour des patients opérés d’une prothèse totale de genou

In patients with severe knee osteoarthritis (OA), total knee arthroplasty (TKA) is performed for both symptom relief and to achieve better function in daily life. Implementation of efficient TKA rehabilitation programs with shorter length of stay (LOS) and reduced medical expenditures is an important issue in clinical practice. However, the effectiveness of preoperative rehabilitation programs is still under debate. Most preoperative rehabilitation programs last many weeks and may be more expensive than TKA. The purpose of this study was to investigate the effects of a simplified, easy-to-learn, and less time-consuming preoperative rehabilitation education program on TKA patients. In this randomzied controlled study, we allocated all the patients into study and control group according to chart number. The study group, which comprised 126 patients, participated in a 40-min preoperative home rehabilitation education program 4 weeks prior to TKA. One hundred and seventeen patients in the control group did not participate in this preoperative program. The study group required a shorter hospital LOS (mean, 7.12 days; P = 0.027) and had less hospitalization-related medical expenditures (mean, 123726 New Taiwan dollars [NTD], equivalent to 4266.4 United States dollars [USD] or 3022.1 [Euros]), ( P = 0.001) than the control group. However, the study group showed no significant improvement in function when compared to the control group. Our study demonstrates that a simplified preoperative rehabilitation program can reduce LOS and increase cost savings. This program was recommended as a routine protocol for OA patients before admission for TKA. Level II. Prospective randomized study.

Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patients

In patients with severe knee osteoarthritis (OA), total knee arthroplasty (TKA) is performed for both symptom relief and to achieve better function in daily life. Implementation of efficient TKA rehabilitation programs with shorter length of stay (LOS) and reduced medical expenditures is an important issue in clinical practice. However, the effectiveness of preoperative rehabilitation programs is still under debate. Most preoperative rehabilitation programs last many weeks and may be more expensive than TKA. The purpose of this study was to investigate the effects of a simplified, easy-to-learn, and less time-consuming preoperative rehabilitation education program on TKA patients. In this randomized controlled study, we allocated all the patients into study and control group according to chart number. The study group, which comprised 126 patients, participated in a 40-min preoperative home rehabilitation education program 4 weeks prior to TKA. One hundred seventeen patients in the control group did not participate in this preoperative program. The study group required a shorter hospital LOS (mean: 7.12 days; P=0.027) and had less hospitalization-related medical expenditures (mean: 123726 New Taiwan dollars [NTD], equivalent to 4266.4 United States dollars [USD] or 3022.1 [Euros]), (P=0.001) than the control group. However, the study group showed no significant improvement in function when compared to the control group. Our study demonstrates that a simplified preoperative rehabilitation program can reduce LOS and increase cost savings. This program was recommended as a routine protocol for OA patients before admission for TKA.

Preoperative Patient Education Reduces In-hospital Falls After Total Knee Arthroplasty

Inpatient hospital falls after orthopaedic surgery represent a major problem, with rates of about one to three falls per 1000 patient days. These falls result in substantial morbidity for the patient and liability for the institution. We determined whether preoperative patient education reduced the rate of in-hospital falls after primary TKA and documented the circumstances and the injuries resulting from the falls. We reviewed data from all 244 patients who underwent primary TKA at a single institution between March and November 2009. Seventy-two patients of one surgeon were enrolled in a preoperative nurse-led education program. This group was compared with a control group of 172 patients who concurrently underwent TKA at the same institution but did not receive preoperative education. More control patients had in-hospital falls than those in the education group: seven (one of whom had two falls) of 172 (4%) versus none of 72 (0%), respectively. Three of the eight falls resulted in a serious injury, including one wound dehiscence and one wound hematoma that both required repeat surgery and one clavicle fracture. Inpatient falls after TKA may be associated with major complications. Our preoperative patient education reduced these falls and is now mandatory for patients undergoing TKA at our institution.

Noise, Numbness, and Kneeling Difficulties After Total Knee Arthroplasty: Is the Outcome Affected?

The sensation of numbness, prosthesis noise production, and kneeling difficulties are generally considered, by most surgeons, minor issues after total knee arthroplasty, but their frequency and relationship to patient expectations and satisfaction have been seldom described. We analyzed 49 patient responses to both an Oxford Knee Score and a separate questionnaire with specific questions about numbness, kneeling, and noise. Of these patients, 69% reported noise production, 71% reported numbness, and 82% reported kneeling difficulties. The mean scores for the magnitude of numbness and kneeling difficulties improved between the time frames of less than 6 months and more than 6 months postoperation, whereas noise scores worsened. None of these changes were statistically significant at the 5% level. Combinations of these issues do affect patient satisfaction and are greater for patients more than 6 months postoperation. A preoperative patient education program, informing patients about these issues, may improve patient satisfaction.

Pre-operative patient education reduces length of stay after knee joint arthroplasty

The aim of this study was to evaluate the impact of a pre-operative education programme on length of hospital stay after surgery for primary and revision knee arthroplasty patients. The programme was introduced at our hospital in October 2006 to encourage patients to play an active role in their recovery process after surgery. A multidisciplinary team educated knee arthroplasty patients about their care pathway, knee surgery, pain management, expected discharge goals, in-patient and out-patient arthroplasty rehabilitation. Prospective data were collected from 472 consecutive patients who underwent (primary or revision) knee arthroplasty in the period between January 2006 and November 2007. Patients were separated into two groups, one that received conventional pre-operative treatment (n = 150; Conventional group) and another that received the pre-operative education (n = 322; Education group). Length of hospital stay was compare using the Mann Whitney U test. In-patient complications, hospital re-admissions within 24 h and 3 months of hospital discharge were compared using the chi-squared test. The mean length of stay was significantly reduced from 7 days in the Conventional group to 5 days in the Education group (P < 0.01). In addition, 20% more patients were discharged early (within 1-4 days) in the Education group compared to the Conventional group (P < 0.01). There was no difference in the percentage of in-patient complications and re-admissions in 24 h (P = 1.00) and 3 months of discharge (P = 0.92) between the two groups. The results suggest that pre-operative education is a safe and effective method of reducing length of stay for knee arthroplasty patients.

A cohort study investigating patient expectations and satisfaction outcomes in men undergoing robotic assisted radical prostatectomy

Robotic assisted radical prostatectomy (RARP) is gaining widespread acceptance for the management of localized prostate cancer. However, data regarding patient expectations and satisfaction outcomes after RARP are scarce. We developed a structured program for preoperative education and evidence-based counseling using a multi-disciplinary team approach and measured its impact on patient satisfaction in a cohort of 377 consecutive patients who underwent RARP at our institution. Responses regarding overall, sexual, and continence satisfaction were assessed. Fifty percent of our patient cohort replied to the questionnaire assessments. Ninety-three percent of responding patients expressed overall satisfaction after RARP with only 0.5% expressing regret at having had the operation. Biochemical recurrence and lack of continence correlated significantly with low levels of satisfaction, though sexual function was not significantly different among those satisfied and those not. Most patients (97%) valued oncologic outcome as their top priority, with regaining of urinary control being the commonest second priority (60%). RARP appears to be associated with a high degree of patient satisfaction in a cohort of patients subjected to a structured preoperative education and counseling program. Oncologic outcomes are most important to these patients and have the largest influence on satisfaction scores.

Preoperative Weight Loss: A Component of the Preoperative Program in Bariatric Surgery

To the editor: With interest we read the letter to the editor by Kalarchian and Marcus [1] regarding the value of preoperative weight loss in bariatric surgery. In their editorial, Tarnoff et al. [2] give a good summary of the literature on preoperative weight loss in bariatric surgery and concluded that the question as to whether it is time to include preoperative weight loss as a component in the preoperative preparation process remains to be fully answered. As pointed out by Kalarchian and Marcus [1], there is unfortunately little evidence regarding how much weight loss is required to obtain the mentioned benefits. Furthermore, it still needs to be established which regimen or diet is best in order to achieve the preoperative weight loss. Kalarchian and Markus are investigating an empirically supported 6-month behavioral weight management program. They anticipate that this will lead to fewer surgical complications and an enhancement of postoperative weight loss. We agree that a preoperative educational program may lead to a better postoperative compliance and better longterm results. However, for this group of patients, 6 months seems to be a very long period, and it could be questioned whether this is necessary, at least if the goal is to reduce surgical complications. Thus, by serial imaging, Colles et al. [3] demonstrated that intake of a very low-energy diet (VLED) significantly reduces liver and abdominal fat by approximately 18.7% over a period of 6 weeks. Interestingly, 80% of the decrease in liver volume was achieved within the first 2 weeks of VLED. We experience that in line with this finding, an increasing number of bariatric surgical centers routinely recommend a 2to 3-week period of low-calorie diets or very low-calorie diets, assuming that this routine will reduce the risk of surgical complications. However, this has never been evaluated properly in high-volume centers with operating times in the range of 50–120 min. Therefore, we are currently conducting a multicenter prospective randomized single blinded study to evaluate the effect of short-term preoperative weight loss using VLED on operative outcome (trial registration no. CT20090015; www.kctr.se). This study was designed by participants of the “European Obesity Academy” (http://www.eoa.nu/). In this program, young specialists join together with experienced senior consultants and scientists in the field of obesity in research and training, with participants in most European countries. We intend to present the results of this study during The International Congress on Obesity in Stockholm, July 2010. With this study, we hope to contribute to the ongoing research with the aim of optimizing our surgical care for the obese patient.

Benefits of Preoperative Education for Adult Elective Surgery Patients

Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience. Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. (c) AORN, Inc, 2009.

Patient Education Before Hip or Knee Arthroplasty Lowers Length of Stay

From April 2006 to May 2007, 261 patients undergoing primary unilateral total hip arthroplasty or total knee arthroplasty were offered voluntary participation in a one-on-one preoperative educational program. Length of stay (LOS) and inpatient data were monitored and recorded, prospectively. Education participants enjoyed a significantly shorter LOS than nonparticipants for both total hip arthroplasty (3.1 ± 0.8 days vs 3.9 ± 1.4 days; P = .0001) and total knee arthroplasty (3.1 ± 0.9 days vs 4.1 ± 1.9 days; P = .001).

Improving practice through involvement in action research

Background This article presents an action research project as a case study to highlight the attributes of this approach in evaluating a health-care intervention, for the purpose of improving it. The action research was undertaken with a group of health-care professionals who wanted to improve a preoperative education programme for patients awaiting a total hip replacement. Content Descriptive detail is provided on the process and justification for action research in this context. The findings and discussion focus on the author's reflections on using action research, rather than the findings in respect of preoperative education. Integral to the action research was the involvement of the health-care professionals. Challenges arose during the research planning which had the potential to undermine the research purpose, but these were addressed to ensure the healthcare professionals were fully involved. Being involved in the action research enabled the health-care professionals to work together for a collective goal of improving their service. Significantly, the action research facilitated their reflections as a means of evaluating and improving their practice. Conclusions Many improvements were made as a result of the action research. These improvements were seen to have three dimensions: improvement in the health-care professionals' theoretical understanding, improvement in their own teaching practices, and improvement in their service outcomes.

An Investigation of the Effects of Preoperative Interdisciplinary Patient Education on Understanding Postoperative Expectations Following a Total Joint Arthroplasty

This study aimed at evaluating the effect of a preoperative interdisciplinary educational intervention on understanding postoperative expectations following a total joint arthroplasty. The study sample consisted of 156 patients scheduled for elective total joint replacement surgery. The approach for this study was a two-group quasi-experimental design. The treatment group received an additional interdisciplinary educational session whereas the control group did not. Subjects who chose to attend the program were compared with those who received standard outpatient teaching in the preadmission testing center. Subjects who received the interdisciplinary teaching intervention were significantly better at verbalizing and demonstrating postoperative skills, and they rated all aspects of the interdisciplinary educational session as very satisfactory. The study demonstrated that the preoperative interdisciplinary educational program for patients scheduled for total joint replacement surgery had a positive effect on the understanding of postoperative expectations. The educational sessions have continued providing an option that will enhance preoperative education.

Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study

Total hip replacement (THR) is a common and costly procedure. The number of THR is expected to increase over the coming years. Two pathways of postoperative treatment were compared in a randomized study. Fifty patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team. A control group (CG) of 23 patients received "conventional" rehabilitation augmented by a stay at a rehabilitation center if needed. All costs for the two groups both in hospitals and after discharge were collected and analyzed. On average total costs for the SG were $8,550 and $11,952 for the CG, a 28% cost reduction. Total inpatient costs were $5,225 for the SG and $6,515 for the CG. In a regression analysis the group difference is statistically significant. Adjusting for changes in the Oxford Hip Score gives effective costs (C/E). The ratio of the SGs C/E to the CGs is 0.60. That is a cost-effectiveness gain of 40%. A shorter hospital stay augmented with better preoperative education and home treatment appears to be more effective and costs less than the traditional in hospital pathway of treatment.