Private health insurer touts short-stay joint replacement amid evidence gap for safety and optimal patient selection

MedTech & Diagnostics News: Cooperation between private hospital operators, medical professionals, and the country’s largest private health insurer, Medibank, has seen over 5,000 individuals navigate the No Gap program for certain procedures including knee and hip joint replacements. However, a recent systematic review and meta-analysis has revealed critical gaps in the safety profile of short-stay joint replacement programs.

The demand for total hip and knee replacement surgeries is on the rise, fuelled by the increasing burden of osteoarthritis and an aging population. The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the United Kingdom (UK) National Joint Registry have reported that delays in accessing joint replacement surgery, combined with growing demand, need to be addressed.

The average stay in Australian hospitals after hip or knee joint replacement surgery is over four days, with many patients having an additional stay for rehabilitation which can be a week or more. In the US, some hip and knee replacements are being performed as day surgery or discharged the next morning.

While systematic reviews have found that short-stay programmes for total hip and knee replacement surgeries reduce healthcare and patient costs, few controlled trials have been conducted on patient safety, including hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, postoperative falls and neurovascular injury.

Milosh Milisavljevic, Medibank Group Executive, underscored the program’s impact, stating, “It provides our customers with greater choice and control when it comes to how and where they access healthcare and what it will cost. For example, our customers are saving on average $1,600 by not paying out-of-pocket fees for joint surgery, but in some cases it is significantly more. It also helps minimise the time a patient spends in hospital, where clinically appropriate, by giving them the option to have rehabilitation in the comfort of their own home.”

Concerns persist regarding the safety profile of short-stay joint replacement programs compared to traditional care pathways. A systematic review and meta-analysis published in December 2023 found “insufficient high-quality trial evidence to support the 90-day safety profile of short-stay joint replacement programmes compared to usual care”.

Ms Milisavljevic pointed to the private health insurer’s No Gap network of 34 private hospitals, saying “Customers don’t have to worry about long surgery waitlists. Almost one third of public patients are waiting more than 12 months for joint replacement, which is a long time to wait when you’re in pain. Medibank customers can have their surgery soon after meeting with their surgeon,”

The authors of the systematic review stressed the importance of further research to determine whether short-stay programmes are safer than usual care pathways, particularly in light of their increasing adoption to reduce healthcare system costs. There also remains an important evidence gap around factors associated with poor outcomes, to guide optimal patient selection for short-stay programmes.

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