210 Participants Needed

Same-Day Discharge Protocol for Total Joint Replacement

(PTClearSHoT Trial)

Recruiting at 1 trial location
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: University of Maryland, Baltimore
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the same-day discharge protocol for total joint replacement treatment?

Research shows that same-day discharge after total joint replacement is feasible and safe for up to 75% of patients, although it may have a higher complication rate compared to fast-track discharge. Proper patient selection is crucial to ensure safety and effectiveness.12345

Is same-day discharge after total joint replacement generally safe?

Same-day discharge after total joint replacement can be safe for carefully selected patients, but it may have higher complication rates compared to other discharge methods. Safety is more established in healthier patients, and a team-based approach is important for effective care.12678

What makes the same-day discharge protocol for total joint replacement unique?

The same-day discharge protocol for total joint replacement is unique because it allows patients to go home on the same day as their surgery, thanks to advances in anesthesia, physical therapy, and surgical techniques. This approach is designed to be safe and cost-effective for selected patients, although it may have higher complication rates compared to fast-track inpatient procedures.23479

What is the purpose of this trial?

Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay.In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process.The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.

Eligibility Criteria

This trial is for adults over 18 who are having a total hip or knee replacement and can go home the same day. They need someone to stay with them at home for a week after surgery and must be medically okay to leave the hospital after waking up from anesthesia.

Inclusion Criteria

I am scheduled for my first hip or knee replacement surgery.
I can go home the same day as my surgery and have someone to stay with me for a week.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Physical Therapy

Participants receive gait and stair training from physical therapy prior to total joint arthroplasty

1 day
1 visit (in-person)

Postoperative Ambulation

Participants ambulate with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization before home discharge

1 day
1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of postoperative falls, ER visits, and readmissions

90 days

Treatment Details

Interventions

  • Conventional postoperative physical therapy clearance
  • Novel same-day discharge protocol after total joint arthroplasty
Trial Overview The study tests if patients can safely skip post-surgery physical therapy before going home on the same day of joint replacement surgery. Instead, they get walking training before surgery and help from nurses trained in moving patients right after.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: Preoperative Physical Therapy, Postoperative Ambulation with NursingExperimental Treatment1 Intervention
Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge
Group II: Conventional Postoperative Physical Therapy ClearanceActive Control1 Intervention
Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Maryland, Baltimore

Lead Sponsor

Trials
729
Recruited
540,000+

Rothman Institute Orthopaedics

Collaborator

Trials
127
Recruited
22,600+

Findings from Research

In a study of 1491 patients undergoing same-day discharge (SDD) total joint arthroplasty, 93% were successfully discharged on the same day, while 7% required a longer hospital stay, often due to factors like being non-married or having higher ASA class (III).
Patients who failed to be discharged the same day (FTL) did not experience worse outcomes compared to those who were successfully discharged, as both groups had similar rates of readmissions, revisions, and patient-reported outcomes, indicating that FTL does not predict adverse results.
Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes.Singh, V., Nduaguba, AM., Macaulay, W., et al.[2022]
A systematic review of 14 studies involving 222,766 cases found that same-day discharge total joint arthroplasty (TJA) has a satisfactory safety profile, with no significant differences in mortality or readmission rates compared to inpatient TJA.
However, same-day discharge TJA showed a significantly higher rate of overall complications compared to fast-track inpatient TJA, indicating that while it is generally safe, careful monitoring for complications is essential.
Same-day discharge arthroplasty has a higher overall complications rate than fast-track arthroplasty: a systematic review and meta-analysis.Li, M., Luo, R., Zeng, Y., et al.[2022]
Same day discharge after total joint arthroplasty is becoming a viable option for selected patients, potentially reducing hospital stays and associated costs.
The review discusses institutional guidelines for patient selection and contraindications, emphasizing the importance of careful evaluation to ensure safety and minimize complications.
Same Day Discharge After Total Joint Arthroplasty The Future May Be Now.Aggarwal, V., Thakkar, S., Collins, K., et al.[2018]

References

Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes. [2022]
Same-day discharge arthroplasty has a higher overall complications rate than fast-track arthroplasty: a systematic review and meta-analysis. [2022]
Same Day Discharge After Total Joint Arthroplasty The Future May Be Now. [2018]
A Formal Same-Day Discharge Total Joint Arthroplasty Program May Not Be Necessary: A Propensity-Matched Cohort Study. [2022]
Same-day discharge to home is feasible and safe in up to 75% of unselected total hip and knee arthroplasty. [2022]
Association Between Same-Day Discharge Total Joint Arthroplasty and Risk of 90-Day Adverse Events in Patients with ASA Classification of ≥3. [2023]
Team Approach: Same-Day Discharge of Patients Undergoing Total Joint Arthroplasty. [2021]
Same-Day Discharge Following Total Joint Arthroplasty: Examining Trends, Discharge Dispositions, and Complications Over Time. [2020]
Outcomes of a Total Joint Arthroplasty Enhanced Recovery Program in a Community Hospital Setting. [2021]
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