Over 200,000 hip and knee replacements are performed in the UK each year. NHS guidelines (Getting it Right First Time) recommend that most hip and knee replacements should be performed as day-cases, with patients leaving hospital on the same day of their operation and recovering safely at home. However, in the UK currently fewer than 1% of patients are discharged on the day of their surgery.
IDAPO seeks to understand why hip and knee replacement surgery is not routinely delivered as day-case procedures and to help hospitals implement pathways that benefit patients.
IDAPO is co-led by Ines Rombach & Antony Palmer. The six-year project is funded by the National Institute for Health and Care Research (NIHR) for £3.8 million and sponsored by Sheffield Teaching Hospitals NHS Foundation Trust. Ines Rombach is a senior medical statistician at the Clinical Trials Research Unit at the University of Sheffield, and Antony Palmer is a clinician scientist orthopaedic surgeon at Oxford University Hospitals and University of Oxford.
Ines Rombach, Senior Medical Statistician and Co-Chief Investigator of the study said:
“Day-case surgery for hip and knee replacements is such an important topic. We are excited to be working with an incredible team to generate evidence to ensure patients are receiving the best care possible.”
Antony Palmer, Clinician Scientist orthopaedic surgeon and Co- chief investigator of the study adds:
“Day-case hip and knee replacement is strongly encouraged in the NHS, and patients receiving day-case surgery have explained that they are very pleased with their experience. However, other patients and their support network express reservations, and not everybody is considered suitable for day-case surgery for medical or social reasons.
We have performed day-case surgery for more than ten years, but still only 1% of patients go home the same day of joint replacement. There is so much to find out about day-case surgery, including patient and clinician views, barriers and facilitators of day-case surgery, and what represents the best clinical care for each individual.”
The project consists of six workpackages, beginning with:
- Analysing data from the National Joint Registry, Hospital Episode Statistics, and Patient Reported Outcomes Measures, the research team will develop an understanding of current practice and outcomes of hip and knee joint replacement surgery nationally.
- Through surveys and interviews with patients, their support network, and healthcare professionals, the team will explore barriers and facilitators to day-case surgery, specifically focusing on people from minority backgrounds and underserved groups.
- The research team will systematically review existing research and pathways to further understand current practice, and explore which interventions enable patients to leave hospital soon after their surgery.
The findings from these first three workpackages will be used to co-design a day-case pathway, including training packages and resources for staff and patients. In a randomised controlled trial, the team will then compare the new implementable day-case pathway with current standard care, when patients stay in hospital for at least one night.
This programme of work will ensure that patients undergoing hip and knee replacements receive the best clinical care. It will ensure tailored care for patients and their support networks to ensure excellent clinical outcomes and patient satisfaction. The research team will update resources for patients and their support networks, and the results will inform national guidance and optimise NHS efficiency.
If IDAPO is successful in developing an efficient day-case pathway, this study has the potential for the NHS to save £40 million annually.