The impact of post-discharge continuity of care on postoperative rehabilitation outcomes in elderly patients undergoing total hip arthroplasty

Abstract

Postoperative recovery of elderly patients undergoing total hip arthroplasty is relatively slow. This study aims to explore the impact of post-discharge continuity of care on the postoperative rehabilitation of elderly hip replacement patients. A total of 240 cases were retrospectively included and randomly divided into 2 groups based on the type of post-discharge care: the routine care group (n = 120) and the continuity of care group (n = 120). The demographic and clinical characteristics of both groups were analyzed. The differences in hip joint function, pain levels, gait ability, balance ability, and coagulation function between the 2 groups were assessed at discharge and 3 months post-discharge. The incidence of complications during the follow-up period was also analyzed. The impact of the timing of continuity of care initiation and the frequency of pain management on postoperative rehabilitation was analyzed using multivariate logistic regression and restrictive cubic spline analysis. At discharge, there were no significant differences in multiple clinical indicators between the 2 groups. Three months after discharge, the continuity of care group showed significant improvements in hip joint function (Harris Hip Score), pain levels (Visual Analog Scale), gait ability (6-Minute Walk Test), balance ability (Timed Up and Go Test), and coagulation function (fibrinogen, D-dimer, activated partial thromboplastin time, thrombin time) compared with the routine care group. There were no significant differences in the incidence of complications between the 2 groups. The timing of continuity of care initiation and the frequency of pain management showed a significant negative correlation with postoperative rehabilitation. Restrictive cubic spline results indicated that this correlation was either linear or near-linear. This study indicates that continuity of care is significantly associated with improvements in hip function, pain level, gait ability, balance ability, and coagulation function during postoperative rehabilitation in patients undergoing total hip arthroplasty. Patients who began continuity of care earlier had better rehabilitation outcomes, and those who used less pain medication had better recovery results.