Study: Inpatient rehab not needed for patients living alone after joint replacement

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A new study undermines the idea that patients who live alone need inpatient rehabilitation care after knee or hip replacement surgery.

Most of those patients can be safely discharged from the hospital directly to their home to recover, researchers report in The Journal of Bone & Joint Surgery.

"Patients living alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty," wrote Andrew N. Fleischman, M.D., and colleagues from The Rothman Institute, Thomas Jefferson University, Philadelphia.

The study included 769 patients, average age 65, who were discharged home after one-sided total hip or knee replacement. Of these, 138 patients lived alone for the first two weeks post-surgery. The researchers compared complication rates and other outcomes among patients who lived alone versus those who lived with others.

More than one-third of patients living alone said that they did not have daily or even weekly visitors, but 79% had someone who could help them within 15 minutes if needed.

The researchers reported patients who lived alone were more likely to spend more than one night in the hospital, and patients living alone also had higher rates of in-home nursing care and physical therapy.

Otherwise, outcomes were similar for patients living alone compared to those who lived with others with an overall post-discharge complication rate of about 8%.

Up to six months after surgery, about 90% of patients who lived alone said they would choose to be discharged home again. However, patients living alone did report more problems attending to personal hygiene.

Some patients who live alone can benefit from home health services or even an extra day in the hospital, the researchers noted. But discharge directly home may be much more economical and help avoid associated risks, according to their study.

One-third of Medicare patients have adverse or harmful events while at an inpatient rehabilitation or skilled nursing facility, according to a report by the US Department of Health and Human Services Office of Inspector General.