Abstract
Aim: To identify the incidence of post-operative morbidity in elective total hip replacement patients as a cause for prolonged admission using the POMS. To assess the utility of POMS as a measure of short term orthopaedic outcome and a tool to influence decision making for appropriate discharge time.
Background: The currently available methods for assessing overall surgical outcome (as opposed to quality of life or joint specific outcome) are generally unreliable, unvalidated, unresponsive and almost always inconsistent. Mortality is usually infrequent and length of hospital of stay is likely to be affected by non-medical factors and monitoring of complications is subject to variations in both definition and intensity of surveillance.
The POMS is the only published method for prospectively describing complications associated with major surgery. It comprises a 9-point survey and provides a generic measure of short term post-operative outcome. Data is simple and quick to collect and easily learnt. No additional tests are required for data collection.
Method: Patients undergoing elective primary and revision hip arthroplasty were recruited. Research assistants collected POMS data prospectively on postoperative days 1, 3, 5, 8 and 15 (if the patients were still in hospital).
Results: 182 patients were recruited and followed-up. Median length of stay was 11 days (range 2–58). Of the patients remaining in hospital on post-operative days 1, 3, 5, 8 and 15, 0% (n=182), 34% (n=61), 30% (n=51), 29% (n=39) and 63% (n=22), respectively, had no evidence of medical morbidity as defined by the POMS.
Conclusions: The POMS is a generic post-operative screening survey, designed to monitor morbidity in all main organ systems. This study suggests that a significant proportion of orthopaedic patients remain in hospital despite having no evidence of medical morbidity as defined by the POMS. Length of hospital stay is influenced by a number of other factors, further investigation is warranted to identify the factors responsible for their post-operative length of stay. We also hypothesize that POMS may be very useful in areas were managed care / insurance companies dictate the length of hospital stays.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
