Role of patient characteristics for fast-track hip and knee arthroplasty

C C Jørgensen, H Kehlet
British Journal of Anaesthesia 2013, 110 (6): 972-80

BACKGROUND: Patient age and comorbidity have been found to increase the length of hospital stay (LOS), readmissions, and mortality after surgery, including in elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Whether the same applies in fast-track THA and TKA with early mobilization and an LOS aim of 2-4 days remains unanswered.

METHOD: A prospective study on patient characteristics and comorbidity in consecutive unselected patients undergoing fast-track THA and TKA was cross-referenced with the Danish National Health Registry and medical charts allowing complete 90 days follow-up.

RESULTS: A total of 3112 THA/TKAs were performed in 3020 patients. The mean age was 67 (range 18-97) years. The median LOS was 3 (inter-quartile range: 1) and the mean 3.0 days (range 1-34), with 91% having LOS ≤4 days. Age 76-80 [odds ratio (OR): 1.57; 95% confidence interval (CI): 0.99-2.47], 81-85 (OR: 2.40; 1.45-4.00), and >85 yr (OR: 4.10; 2.15-7.82), preoperative cardiopulmonary disease (CPD) (OR: 1.40; 1.03-1.91), preoperative use of a mobility aid (OR: 1.95; 1.46-2.54), and living conditions (OR: 1.92; 1.44-2.54) were related to LOS >4 days. However, more than 75% of those aged over 80 yr or with these conditions had an LOS ≤4 days. Mortality and readmission rate were 0.22% and 6.6%, respectively, at 30 days and 0.42% and 9.3% at 90 days. Readmissions were similarly related to older age, CPD, and use of mobility aids.

CONCLUSIONS: Fast-track THA and TKA with LOS of ≤4 days and discharge to home is feasible and safe, including in elderly patients with comorbidities.

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