Shorter stays in hospital after hip replacement

(From left) SGH's Ms Eleanor Chew, hip replacement surgery patient Lionel Liew, Dr Pang Hee Nee and nurse clinician Rajashulakshana Rajaram at the launch of the enhanced recovery programme last week. Singapore General Hospital physiotherapist Eleanor
(From left) SGH's Ms Eleanor Chew, hip replacement surgery patient Lionel Liew, Dr Pang Hee Nee and nurse clinician Rajashulakshana Rajaram at the launch of the enhanced recovery programme last week.ST PHOTO: DESMOND WEE
(From left) SGH's Ms Eleanor Chew, hip replacement surgery patient Lionel Liew, Dr Pang Hee Nee and nurse clinician Rajashulakshana Rajaram at the launch of the enhanced recovery programme last week. Singapore General Hospital physiotherapist Eleanor
Singapore General Hospital physiotherapist Eleanor Chew and Mr Lionel Liew demonstrating how patients are aided in walking after hip replacement surgery. Mr Liew went for the operation last September.ST PHOTO: DESMOND WEE

New SGH recovery programme lets patients go home within a day instead of up to 5 days

A hip replacement is considered major surgery and a major worry for those who are going for one.

A new programme launched this month by Singapore General Hospital (SGH) can help patients in two ways - it enables patients to cut short their stay in hospital and makes it easier on their wallets too.

The launch of the enhanced recovery programme comes after a successful pilot that began last January.

Mr Lionel Liew Kong Chung was one of 30 patients selected for the programme.

He had felt pain in his right hip and was referred to SGH's department of orthopaedic surgery.

"I underwent an X-ray and found that the cartilage in my hip was worn out," said the retired lawyer, 64, who was diagnosed as having severe osteoarthritis in the hip.

He tried taking supplements but the pain did not go away. When it got so bad that he could not even bend to put on his socks, he was advised to go for a total hip replacement.

Mr Liew, who went for his surgery last September, said the programme was well run.

He was one of the 80 per cent of patients in the pilot who were able to go home within 23 hours of the surgery, compared with the typical four to five days in hospital.

The 30 patients selected for the pilot programme were generally fit, able to perform normal daily activities and had good family support.

Together with their family members or caregivers, they attended a newly introduced Joint Replacement Class where they were given pre-surgery instructions and taught pain management and wound care, diet and nutrition, and rehabilitation exercises.

  • 30

    Number of patients selected for the pilot of the enhanced recovery programme. This began last anuary. 

  • 80%

    Percentage of patients in the pilot who were able to go home within 23 hours of surgery, compared with the typical four to five days in hospital.

Dr Pang Hee Nee, consultant at SGH's department of orthopaedic surgery, said the class was necessary to help patients appreciate the benefits of same-day discharge after a total hip replacement as it "may sound unbelievable to some patients as they feel they should stay in bed for a few days after major surgery".

Added Dr Pang: "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."

A stay of four days in a Class B2 ward, for instance, costs $11,700, compared with $9,400 for one day, before MediShield Life claims.

After the surgery, patients rest in a short-stay ward and, if they do not feel nauseous and can walk after the operation, they will be discharged. They can also opt to rest overnight in the same ward.

Said Dr Pang: "A proper assessment will be done through the night and they may be discharged by 7am the next morning - all within 23 hours."

In the pilot programme, before a follow-up review with the surgeon, SGH physiotherapists and community nurses made home visits in the first two weeks to assess the patients' recovery progress and to aid them in walking and doing leg exercises.

Patients were also given a helpline number manned by an advanced practice nurse.

Mr Liew said: "It was very comforting because the exercises and walking were done in a familiar environment - where I live and recuperate."

SGH has been encouraging patients to move around the same day after their hip replacement operation since 2016, joining overseas centres such as the Mayo Clinic in the United States in doing so.

The new programme is made possible by the adoption of a minimally invasive surgical technique which pulls apart the thigh muscles to get to the damaged hip joint, unlike the standard muscle-cutting technique.

An average of 300 patients undergo total hip replacement at SGH each year, and about half of them will be able to benefit from the enhanced recovery programme.

A version of this article appeared in the print edition of The Straits Times on January 22, 2020, with the headline 'Shorter stays in hospital after hip replacement'. Print Edition | Subscribe