Failure to Participate in Pre-operative Arthroplasty Education is Associated with Longer Length of Stay and Lower Rates of Same-day Discharge and Discharge Home

Introduction Hip and knee arthroplasty continues to evolve with better techniques, protocols, and outcomes. Patient education is critical to disabuse patients of outdated expectations about surgery and recovery. Formal preoperative education programs are widely used, but not all patients participate. This investigation seeks to evaluate length of stay and functional outcomes in patients who do not participate in a preoperative education class compared with those who do. Methods 376 consecutive patients over 6 months having primary hip and knee arthroplasty at an urban academic medical center were retrospectively reviewed. Patients who did not participate in education (n=17) were compared to those who did (n=359). The primary outcome was mean length of stay (LOS); secondary outcomes included improvement in knee motion, discharge to home rates, and same-day surgery rates. Results Patients who failed to participate had longer LOS (2.2 vs 1.2 days, p<0.001) and lower rate of same-day surgery (0% vs 24.0%, p=0.045). Participants had a higher rate of home discharge (90.3% vs 52.9%; OR 8.23; 95% CI [2.98, 22.7]; p<0.001). We found no significant differences in change of knee range of motion. Conclusion Patients not participating in preoperative education were associated with a longer hospital admissions and were more likely to fail planned discharge home after hip and knee arthroplasty. This study corroborates multiple prior studies showing the importance of preoperative education.