Article

We compared patients' evaluation of care between a surgical unit with
a rapid discharge policy and two comparison units to test the hypothesis that the
centre with rapid discharge has outcomes that are not inferior to those of the
comparison sites. Design: Cross-sectional cohort study. Subjects: Consecutive
consenting patients undergoing primary hip arthroplasty during 12 months in: a
unit that had reduced postoperative stay to median three days; a specialised
orthopaedic surgery treatment centre with median stay of five days; a traditional
unit with median stay of six days (N = 316, 125, 119, respectively). Methods: Six
weeks postoperatively, patients completed a specially developed questionnaire
measuring their evaluation of care and recovery, together with measures of
function and quality of life for validation purposes. Results: Factor analysis of
questionnaire responses identified two independent components of patients'
evaluation: problems in staff care and problems in physical recovery. Neither
component was impaired in the unit with rapid discharge: similar proportions of
patients reported recovery problems in each site (odds radios (ORs) for the two
comparators versus unit with rapid discharge: 0.96, 1.18) ;
and more patients
reported care problems in the two comparator sites (ORs 2.97, 2.16). Conclusion:
Duration of stay after primary hip arthroplasty can be reduced to three days
without intensive pre- or postoperative care, without detriment to patient evaluation.

Langue : ANGLAIS