Friday, November 02, 2018

My Day Zero Discharge Post Hip Replacement


I went on a wait list for an elective total hip replacement in October 2017. I had nagging pain in my right hip for about three years and was surprised at the amount of damage shown on X-rays. I was still active and working full time but my surgeon warned me that hip degeneration can progress quickly. I completed a few weeks of physiotherapy treatment in the summer and then reluctantly went on the surgical wait list knowing my turn would not come up for a year.

By April 2018 the hip pain was interfering with my daily activities and sleep. I rapidly lost range of motion in spite of regular exercise and biking and work became more of a challenge. In July 2018 I received a surgical date for September 28, 2018. I arranged for a six month leave of absence starting in mid-September and began counting down the days until the procedure. I continued to exercise as much as possible but my ability to walk recreationally was limited. My routine was work, mat exercises, biking in the evening and then a restless sleep.

On September 27, 2018, I received a phone call from the hospital stating that my surgery the next day was cancelled due to bed shortages. I was devastated! I had discontinued my anti-inflammatory medication a few days before and was in a lot of pain. A new surgical date of October 16 was assigned but it was possible that surgery could be cancelled again. 

A week before the rebooked surgery, I was contacted by a hospital manager who asked if I would be interested in being the first patient at this hospital to try a same day discharge following hip replacement surgery. I knew this was a new initiative at some Toronto hospitals and was eager to be the test patient locally. After a couple of days, the surgical team agreed that I would be a good candidate for a Day #0 discharge and was informally assured that my surgery would not be cancelled again.

A few procedural changes were implemented to make the day a success. My spinal anaesthetic did not contain morphine and I was given a couple of IV boluses to help maintain my blood pressure during early mobilization after surgery. Preoperatively, my nurse calmed me with warm blankets and a reassuring approach rather than using Ativan. I was given the option of being conscious during surgery but left the decision to the surgical team and was sedated. 

Daily walks on my street are now up to 400 m
My surgery was at 8 AM and at 9:30 AM I was awake in the recovery room. Within 30 minutes I was able to move my feet and was transferred to the surgical unit. I walked to the bathroom with supervision at 11 AM and had lunch at noon. So far things were going exceptionally well and I was very confident! In the early afternoon I went up and down a flight of stairs with crutches and took a couple more walks in the room and hallway with a walker. Later in the afternoon I had an episode of low blood pressure while sitting up in a chair but recovered quickly after the nurse helped me back to bed. This is a common but alarming postoperative event that can lead to fainting and falls but it was good to bring my over confidence down a few notches.

I was discharged home at 6 PM and transferred easily into the car with my husband’s help. At home, I had the best sleep in months. My surgeon phoned in the evening to see how I was doing and I had calls from the surgical nurse practitioner the next two days. A home care physiotherapist visited the next morning. 

I am now 17 days post op and am making daily gains in strength and function. The first week had its ups and downs with pain control, but I had support from the surgical team at the hospital and my RN daughter who travelled from Ottawa to be with me for a few days. I am grateful to all my family for being available to me 24 hours a day at first and would not have been successful without them.

I have been a physiotherapist in this community since the mid-1970s and have seen literally thousands of post-operative hip patients, particularly when I worked in the home care sector. Early in my career, patients stayed in hospital for two weeks and went home after their incision healed. They spent the one week on the surgical floor and the second week on the rehab unit. Length of hospital stay for elective hip and knee surgery shortened over time to one week, five days and then one to three days as surgical techniques improved.

My knowledge and experience as a physiotherapist was very helpful of course, but being a joint replacement patient and dealing with pain and medication side effects first hand was a new experience. I am not keen on doing exercises that hurt and need to be encouraged like anyone else. I am attending a physiotherapy clinic as an outpatient because I can not assess myself objectively. I cannot drive for another month and require several months of healing and rehab to achieve my maximum potential. My goal is to return to work.

Wait times for joint replacement surgery have increased significantly in the last year in south-western Ontario and people are now waiting up to 20 months for elective orthopaedic procedures at some hospitals in this region. (Other hospitals in Ontario have much shorter wait times and this information is available online from the Ministry of Health.) My cohorts in the baby boomer generation will increase the numbers of people waiting for joint replacements for many more years. Earlier discharge from hospital after surgery allows for improved bed flow and potentially more surgeries could be accommodated. 

Good preoperative preparation is very important. I attended two clinics before surgery. At the first one a physiotherapist reviewed the equipment I needed and went over my exercises. The second was a medical assessment and teaching with the nurse, pharmacist and anaesthesiologist. It is important to have the right equipment set up at home and to understand your medications before surgery.

I had a followup appointment at the hospital yesterday and am doing very well. I am grateful to an excellent surgeon, the entire surgical team, community partners and my family for making this Day #0 discharge a success! 


10 comments:

  1. WOW! I did not realize that one could be discharged the same day. To me that sounds scary, but I guess it can works you have proven.

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    1. There is a lot of preoperative education for the surgery and support afterward. For patients who are generally healthy it can work very well.

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  2. It seems like your post-op follow up was pretty good in this method.

    I suppose I should consider getting on the list for knees. :-(

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    1. The waits list are a little shorter in your area. I did consider coming that way. You should get an assessment sooner rather than later. (Esp considering the ankle)

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    2. I looked into the ankle years ago but was told that I couldn't bear weight for 6 months. I couldn't cope with that especially with knees in such bad shape.

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    3. Things have changed a lot since "years ago" as my story proves. Surgical techniques and materials have improved significantly. I plan to go on the list for a knee replacement this week but it will be quite a while until my turn comes up.

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  3. Wow! That is a very long wait! I wish you all the best with full healing.

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  4. Thank you GInger. I was lurking about last evening looking to see if you were still blogging. Yes, we have varying wait lists for elective surgery. But you would not be turned away from a Canadian hospital if you had an urgent need. A hip fracture moves to the front of the line ahead of a hip replacement. I know there are politicians in America who have used our wait times as criticism of universal health care but they do not look at the big picture.

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  5. Well Congrats! I admire your strength and fortitude for undergoing this procedure and doing so well. Being prepared and with a team of professionals to support you seems to be a formula for success.

    As an aside, my daughter is an RN too. And I have a son living in Ottawa. Small world, isn't it?

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    1. It is a small world, but I wish Ottawa was an hour away instead of five!

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