There may be no place like home after joint replacements

Knee-300x166Hip and knee replacements, especially among seniors, have become so prevalent that almost 7 million Americans by 2010 had undergone the surgeries. With the cost to Medicare of knee replacements running between $16,500 and $33,000, and with roughly half of the procedures’ expense occurring post-operatively, there’s some good news for patients on saving money—and staying safer too.

Patients may want to get themselves out of the hospital and stay out of in-patient rehab centers in favor of well-planned, careful recuperation at home, studies show. The research focused on single adults living alone, and whether they fared better over the short- and long-term by rehabbing from total knee and hip replacements at skilled nursing facilities or at home, particularly if their home care was well considered and followed through.

They did at least as well and were happier recuperating at home, researchers found, adding that they also may have been safer: That’s because a third of patients in rehab facilities suffered adverse events in their care, a rate comparable to unacceptably high hospital harms and those in skilled nursing facilities.

Even if knee- and hip-replacement patients spend an extra day in the hospital, then headed home, they saved $10,000 or so on their surgeries, the New York Times has reported.

I’ve written that surgeons and hospitals have made advances in complicated knee and hip replacements, such that these procedures have become more routine. They’re a big deal still, not to be downplayed for many patients, and with so many Americans, especially seniors, undergoing the procedures, making them more comfortable and less costly could be important.

It also may be that doctors and health systems need to consider more carefully how readily they recommend and perform knee replacements. A new study published in BMJ, a prominent British medical journal, found that some patients had relatively minor complaints before they underwent knee surgeries, which had limited benefits. The researchers said there are other, less invasive alternatives to replacements that should be explored for patients, particularly due to the high cost of more extensive procedures.

In my practice, I see the significant harms that patients can suffer while seeking medical services. I’ve written a lot about medical care facilities’ pernicious challenges in curbing errors that injure patients: As many as 1,000 patients a day may be dying due to medical errors in hospitals alone, making medical error one of the leading causes of Americans’ deaths, lagging only cancer and heart disease. It may be an odd sounding prescription. But many patients, apparently including knee and hip surgery patients, may stay healthier by staying out of medical care, including by rehabbing as much as they can at home.

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