Prehabilitation in Paediatric Orthopaedic Surgery Reduces Hospital Length of Stay

Abstract

Purpose: In 2019, the results of the first James Lind Alliance (JLA) research priorities setting partnership (PSP) in paediatric orthopaedics were published in the form of 10 top questions. One of which was, "What is the clinical and cost effectiveness of pre-operative rehabilitation in children presenting with lower limb orthopaedic conditions?" The purpose of this study was to assess the clinical and cost effectiveness of simple pre-operative rehabilitation (prehabilitation) strategies, as measured by hospital Length of Stay (LoS). Patients and Methods: Clinical records were reviewed retrospectively to determine the average LoS for patients who underwent lower limb paediatric orthopaedic surgery before any prehabilitation intervention. Prehabilitation intervention strategies were introduced, including patient education, provision of crutches and goal setting and subsequent data was collected. LoS before and after intervention were compared. In addition, extra bed days, defined as the difference between actual and expected LoS (determined by the treating clinician with reference to national data), were compared. Results: Before intervention, the average LoS after paediatric orthopaedic surgery in our hospital was 2.95 days (range 12 days; standard deviation (SD) 2.20 days) and after intervention, the average LoS was reduced to 2.70 days (range 7 days; SD 1.84 days). These data showed an 8% reduction in hospital LoS after the introduction of prehabilitation. Further, there was a significant (p=0.024) reduction in extra bed days (per patient) from 1.12 days (range 14 days; SD 1.61 days) before intervention to 0.72 days (range 8 days; SD 1.45 days) after intervention, equating to an estimated saving of £46,500 in hospital bed costs only. Conclusion: This data indicates that simple prehabilitation strategies can reduce hospital LoS by 8% indicating improved clinical outcomes. Further, extra bed days may be reduced by 36% with potentially important cost savings.