Singapore, 16 January 2020 – Patients undergoing total hip replacement surgery typically stay in the hospital for a period of 4 to 5 days. But an enhanced recovery programme piloted at Singapore General Hospital (SGH) last January enabled a group of patients to go home hours after surgery. SGH is the only hospital in Singapore to offer same-day discharge for this elective surgery.
About 30 patients were selected for the pilot programme. They were generally fit, able to perform normal daily activities, and had good family support. Together with their loved ones/caregivers, they attended a newly introduced Joint Replacement Class where they were given pre-surgery instructions, taught pain management and wound care, diet and nutrition, rehabilitation exercises, etc. from a multidisciplinary team comprising an orthopaedic-trained Advanced Practiced Nurse (APN), Physiotherapist and Occupational Therapist. The class was held on the same day as their pre-operative tests at the Pre-Admission Centre.
“Same-day discharge after a total hip replacement may sound unbelievable to some patients as they felt they should stay in bed for a few days after a major surgery. We realised the need to help them appreciate the benefits of same-day discharge and to provide a platform to better address their concerns. Hence, the Joint Replacement Class was introduced,” said Dr Pang Hee Nee, Consultant, Department of Orthopaedic Surgery, SGH, and programme lead.
“As soon as the anaesthesia wears off, patients are encouraged to get off the bed to walk. Doing so lowers their risk of possible post-surgery complications such as blood clots, and patients can go home earlier with a smaller bill.”
The surgeons also adopted the direct anterior approach (DAA), a minimally-invasive surgical technique in all 30 patients who underwent total hip replacement in this pilot programme. They pulled apart the thigh muscles to get to the damaged hip joint unlike the standard muscle-cutting technique. SGH performed its first case of DAA total hip replacement in 2015.
About 80 per cent of the patients recruited for the pilot programme were discharged within 23 hours after being reviewed by the care team. Before they returned for follow-up review with the surgeon, home visits by SGH Physiotherapists and Community Nurses were arranged in the first two weeks to assess the patients’ recovery progress. Patients were also given a helpline number manned by an APN should the need arise between the visits.
An average of 300 patients undergoes total hip replacement at SGH each year, and about half of them will benefit from the enhanced recovery programme which was officially launched in January 2020.
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