Physical therapy before joint replacement surgery can reduce the need for postoperative care by nearly 30%, saving an average of $1,215 per patient in skilled nursing facility, home health agency or other postop care, according to a new study.
An estimated 52.5 million U.S. adults have physician-diagnosed arthritis, according to the CDC, and patients often need THR or TKR to maintain mobility as the condition progresses. An earlier study projected the number of THRs is expected to grow by 174% (572,000 patients) between 2005 and 2030, and TKRs by 673% (3.48 million). The hospital length of stay after surgeries has decreased from an average of 9.1 days in 1990 to 3.7 days in 2008, according to a release from the American Academy of Orthopaedic Surgeons, while post-acute care costs have grown.
Researchers used Medicare claims data to identify preoperative PT and post-acute care use patterns for 4,733 THR and TKR patients. For the study, post-acute care was defined as the use of a skilled nursing facility, home health agency or inpatient rehab center within 90 days after hospital discharge. Home health agency services included skilled nursing care, home health aides, PT, speech therapy, OT and medical social services.
The study was published Oct. 1 in the Journal of Bone & Joint Surgery.
The researchers found 77% of patients used care services after surgery. After they adjusted for demographic characteristics and comorbidities, researchers found patients who received preoperative PT showed a 29% reduction in postop care use. Other findings include:
54.2% of the preoperative PT group required postoperative care services, compared with 79.7% of the patients who did not have preoperative therapy.
The decline in postoperative care services resulted in an adjusted cost reduction of $1,215 per patient, largely because of lower costs for skilled nursing facility and home health agency care.
Preoperative physical therapy cost an average of $100 per patient, and generally was limited to one or two sessions.
This study demonstrated an important opportunity to pre-empt postoperative outcome variances by implementing preoperative physical therapy along with management of comorbidities before and during surgery, study co-author Ray Wasielewski, MD, said in a news release. Wasielewski is the director of OhioHealth Orthopedic Surgeons in Columbus, Ohio.