Modifying Patient Expectations Can Enhance Total Hip Arthroplasty Postoperative Satisfaction

J Arthroplasty. 2019 Jul;34(7S):S209-S214. doi: 10.1016/j.arth.2018.12.038. Epub 2019 Jan 6.


Background: A better understanding of patient expectations within the perioperative setting will enable clinicians to better tailor care to the needs of the total hip arthroplasty (THA) recipient. Such an approach will promote patient-centered decision-making and optimize recovery times while enhancing mandated hospital quality metrics. In the present study, we preoperatively and postoperatively surveyed THA candidates to elucidate the relationship between patient expectations and length of stay (LOS).

Methods: This is a multi-institutional prospective study among THA candidates. Patients were surveyed regarding discharge planning 1 week preoperatively and postoperatively to capture perioperative patient expectations and correlate with inpatient LOS.

Results: In total, 93 THAs performed by 6 high-volume orthopedic surgeons at 2 medical centers. Our results demonstrated that patients of male gender and commercial insurance had significantly (P < .05) shorter LOS. Shorter LOS patients demonstrated significantly higher levels of LOS acceptance ("very comfortable" rate in same-day discharge: 75.0% and next-day discharge: 63.8%; 2 days: 40.7%; 3+ days: 42.9%; P < .05) and a higher likelihood to participate in SDD programs. Postoperatively, patients with a shorter LOS had more acceptance to their LOS, albeit not statistically significant (P = .20).

Conclusion: Our results suggest that guiding patient expectations within the perioperative setting is an essential component for successful and timely discharge after THA. Having clear and transparent discussion with the surgical team regarding the perioperative course can improve a THA candidate's understanding and buy-in with the postoperative plan, regardless of LOS. Finally, inpatient LOS does not appear to affect patient satisfaction.

Level of evidence: Level II, prospective observational study.

Keywords: length of stay; patient education; patient expectations; patient satisfaction; patient-reported outcomes; total hip arthroplasty.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / methods*
  • Decision Making
  • Female
  • Hospitals
  • Humans
  • Inpatients
  • Insurance, Health
  • Length of Stay
  • Male
  • Middle Aged
  • Motivation*
  • Orthopedics
  • Patient Discharge
  • Patient Satisfaction*
  • Patient-Centered Care
  • Postoperative Period
  • Preoperative Care / psychology*
  • Prospective Studies
  • Surveys and Questionnaires