The average length of stay after a hip or knee replacement at Rivers Hospital in 2020 was 2.5 days, an excellent figure in comparison to national averages which are between 3 to 4 days. Mr Kosuge is pleased to report that the length of stay for his patients was even shorter, at an average of 1.9 days for hip replacements and 2.1 days for knee replacements. This would not have been possible without the help of the team Mr Kosuge works with at Rivers Hospital. Mr Kosuge would also like to thank his patients as it is their motivation and determination that also plays a key part in the success. Mr Kosuge continues to review his practice to explore ways of improving processes so that length of stay can be reduced further.

There are many factors that determine length of stay and these include patient factors such as the family/social support available, co-existing medical illnesses (e.g. heart or lung problems, anaemia). Surgeon factors can also affect length of stay and these include surgical and anaesthetic techniques used.

Increased hospital stay after surgery is associated with increased serious complications such as blood clots in the deep veins of leg (deep vein thrombosis) or lungs (pulmonary embolus), and infection of the joint replacement. Reducing hospital stay has the advantages of improving patient satisfaction as many patients prefer to recover in the comforts of their own home with family, a familiar bed and diet. The COVID-19 pandemic has also made the concept of early discharge palatable for most patients. It is for these reasons that Mr Kosuge is keen on his patients being discharged early and he spends time in the weeks leading up to surgery to prepare his patients for this . Pre-operative education of patients is very important as with appropriate expectations, it is very possible to achieve a short length of stay.

The average length of stay in hospital for hip and knee replacements have reduced gradually from being over two weeks back in the 1990s, to approximately four days in the UK now. The concept of ‘day-case’ joint replacement is also gaining popularity and Mr Kosuge is confident that discharging patients home on the same day of surgery will be possible at Rivers Hospital in 2021, for pre-selected patients. Safety netting measures will be put into place to ensure that all patient concerns can be dealt with in the immediate post-operative period. If you are interested in the concept of ‘day-case’ hip or knee replacements, please do not hesitate to make enquiries when having your consultation with Mr Kosuge.