EFFECT OF FIVE VS. SEVEN DAY PHYSIOTHERAPY ON ACUTE CARE LENGTH OF STAY IN TOTAL JOINT REPLACEMENT (TJR) PATIENTS

Abstract

This study examined the effect of seven vs. five day physiotherapy on hospital LOS for total joint replacement (TJR) patients. 1055 consecutive TJR patients were studied. Seven day PT significantly reduced LOS for TJR patients (0.73 days) and the subgroup of total hip replacement patients (0.80 days). Decreases in TJR LOS reduced hospital costs by $100,000. Older patients and patients with greater co-morbidities had a longer LOS with both five and seven day PT, but their LOS was less with seven day PT. This study provides strong evidence for providing seven day PT for TJR patients.

The purpose of this study was to determine the effect of five vs. seven day/week physiotherapy (PT) on acute care, length of stay (LOS) for TJR patients.

The inpatient discharge abstract database was used to retrospectively identify TJR patients who were admitted on January 1, 2000 or later and discharged by March 31, 2002 or earlier. Patients were excluded if they died in hospital or were discharged to another acute care facility. PT was enhanced from five to seven days/week on March 10, 2001. This date was used to divide patients into PRE and POST (enhanced PT) groups. Differences in LOS (PRE vs. POST) were analyzed for all TJR, and separately for THR (total hip replacement) and TKR (total knee replacement) patients, using t-tests. Potential interactions between group (PRE, POST) and age (young < 70 yrs, old ≥ 70 yrs), gender, and co-morbidity were analyzed with two-way ANOVA’s (group x other variable). LOS acute care savings were calculated using the unit-specific per diem cost.

1055 patients were studied. LOS was significantly reduced for TJR (0.73 days) and THR (0.80 days) patients. TJR decreases in LOS reduced acute care costs by $100,000. Age and co-morbidity had significant main effects but no interaction on LOS.

LOS and hospital costs were reduced for TJR patients with seven day PT. The fact that a decrease in LOS was seen in a large sample, in both young and old patients and patients with and without comorbidities, provides strong evidence to support seven day PT for TJR patients.