This is a story about “same-day” hip replacement surgery. The story gives readers the impression that a few pioneering institutions are offering patients a superior procedure, when the reality is that hospital stays after hip replacement have been steadily shortening for many years, to the point that it is not unusual for some otherwise healthy patients to go home without spending a night in the hospital.
The story includes important cautions from a skeptical surgeon, but the prominence of the surgeon and institution that are actively marketing this procedure results in a story that implies greater benefits and fewer risks than there is evidence to support. The same surgeon and hospital were featured in a Wall Street Journal story that we reviewed in February.
There are more than 300,000 hip replacement procedures performed in the United States each year. The many hundreds of thousands of people who have hip pain and are considering hip replacement need news stories that clearly and precisely state the benefits and harms of the various procedures.
There is no discussion of the costs of hip replacement, even though it is a common procedure and its costs are widely discussed. For example, a Blue Cross Blue Shield report noted an average cost of about $30,000, but with wide variations, ranging between “$11,327 in Birmingham, Alabama, and $73,987 in Boston.”
The basic premise of the story is that “same-day” hip replacement offers important advantages to patients, but the only benefit specifically noted in the story is that people who opt for this procedure are less likely to spend a night in the hospital. Even then, there are only vague references and quotes from the surgeon on how many patients really go home the same day. Indeed, the one patient named in the story did not go home the same day.
The story does note that studies following hip replacement patients for at least six months find no important differences in how they fare depending on which sort of procedure they had. Still, the overall thrust of the story is that “same-day” is superior, without critically evaluating the differences between going home that day or the next.
We will give the story a Satisfactory rating on this criterion because it includes comments from a surgeon who warns about the risk of serious complications during the first night after surgery.
However, the most prominent voice in the story is a surgeon who dismisses those concerns by saying, “if the pain is controlled and the patient is healthy and medically completely stable there is no reason for them to be in the hospital. It really doesn’t make sense.”
We’re not given any information or data that proves this “doesn’t make sense,” though.
We also think potential harms that could have been included are falling at home due to dizziness, or otherwise not being adequately prepared for managing under major surgery.
The story does mention one study that found no difference in longer term outcomes of two types of hip replacement procedures. However, it fails to note that there are few good studies comparing outcomes of different types of hip replacement procedures and that the choice may rest largely on the personal experiences and preferences of individual surgeons, rather than robust scientific evidence.
The story does not exaggerate the extent of hip problems or the relevance of replacement surgery to people with chronic hip pain.
This does appear to target younger, healthier people, and surgery for them comes with special considerations–a hip replacement has a 20 to 25 year life span, less when put into a more physically active person. So, younger people may face a second procedure at an older age. When deciding on the timing of the first procedure, this should be considered since second surgeries are more involved and higher risk.
This story does include a surgeon who is skeptical of the benefits of “same-day” hip replacements. However, as noted above, the surgeon advocating the “same-day” procedure is featured far more prominently, likely creating an imbalance in reader perceptions. But the main reason for marking down the story on this criterion is that it fails to tell readers that NYU Langone has a marketing campaign tied to “same-day” hip surgery. The result is that the story supports the promotional efforts of the hospital and its surgeons without alerting readers to the commercial aspects of the matter.
The hospital tweeted an image of an earlier story on “same-day” hip replacement, indicating the marketing department understands the value of friendly coverage. HealthNewsReview.org also reviewed that Wall Street Journal story.
As noted above, the story exaggerates the differences between hip replacements billed as “same-day” and those that give patients more conservative timelines.
The story offers examples of hospitals currently offering “same-day” hip replacements. If anything the story understates the availability of the procedure.
However, the story could have been more clear about who this procedure is most available to, since this won’t be the right option for some people. For example, if they don’t have help at home, or if they live far from the hospital.
The story implies “same-day” hip replacement is new. While the practice is becoming more common, it is part of a long-term gradual trend toward shorter hospital stays, rather than a sudden break with past practice. In fact, reports on the technique note that over a decade ago some hip replacement patients were discharged the same day. The impression that NYU Langone Medical Center has a new type of procedure appears to be more marketing spin than medical fact.
The story includes original interviews and other reporting.