Fast-track versus conventional surgery in relation to time of hospital discharge following total hip arthroplasty: a single-center prospective study

Abstract

Background Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints. Methods Ninety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS, and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Student t test, and Poisson regression approach. Results The FTS and control groups were similar in age and sex distribution (p > 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p < 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001). Conclusion Use of FTS was associated with decreased LOS, compared with conventional THA. Trial registration https://www.researchsquare.com/article/rs-369025/v1.

Enhanced Recovery after Total Joint Arthroplasty (TJA): A Contemporary Systematic Review of Clinical Outcomes and Usage of Key Elements

“…Finally, 24 studies (n = 216,708) published after 2017 were included; these studies compared the traditional care or controlled pathway (n = 209,330) to ERAS (n = 7378) strategies (Table 1 ). Of these studies, 14 studies 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 retrospectively compared the ERAS pathway with historical or standard controls, and eight 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 prospectively described ERAS pathways with associated controls. The remaining two 35 , 36 studies were conducted as RCTs.…”

“…Among them, 84.6% (11/13) chose a spinal‐preferred anesthetic protocol. Only two studies 17 , 18 reported that both spinal analgesia and general anesthesia were acceptable. However, Palanne et al 37 found through a randomized controlled trial that for TKA patients, spinal anesthesia shared a similar condition with general anesthesia in terms of 24‐h postoperative opioid consumption, pain management, blood transfusions, in‐hospital complications, and length of hospital stay; however, vomiting incidence in the spinal anesthesia group was higher than that in the general anesthesia group.…”

“… 47 , 48 A total of 41.7% (10/24) of the studies highlighted the importance of perioperative surgical factors in their ERAS protocols. Sixty percent (6/10) of studies 13 , 14 , 16 , 33 , 35 , 36 reported the use of specific surgical approaches; 50% (4/8) of studies 13 , 20 , 30 , 36 with knee replacement highlighted the reduced or abandoned use of tourniquets; and 60% (6/10) of studies 13 , 14 , 18 , 20 , 22 , 36 did not support the routine use of drains. Furthermore, only two studies 13 , 36 supported the use of specific surgical approaches and reduced or abandoned the use of tourniquets and drains.…”

Assessment of Fast-Track Pathway in Hip and Knee Replacement Surgery by Propensity Score Matching on Patient-Reported Outcomes

“…The Fast Track surgical procedure (FT) is defined as a coordinated perioperative approach [ 3 , 8 ] that strives to lessen the physiologyical and psychological stress associated with surgery, with the aim of expediting early mobilization and recovery following surgery [ 7 ] and, accordingly, shortening the length of hospital stay (LOS) [ 9 ], decreasing convalescence [ 10 ] and lowering costs [ 11 ], while maintaining patient safety and without increasing readmission rates [ 12 ]. In this view, based on the patient’s condition, rapid rehabilitation surgery optimizes traditional rehabilitation methods, by integrating evidence-based practices into the procedure [ 13 ].…”

An all-arthroscopic light bulb technique to treat osteonecrosis of the femoral head through outside-in fashion without distraction: A case report

“…Recently, fast-track surgery (FTS) has become the goal for managing hip lesions. FTS is an evidence-based multimodal approach that can shorten rehabilitation time and improve clinical results, including reductions in both mortality and morbidity, thereby significantly decreasing the time taken to reach hospital discharge and optimizing patient satisfaction (4). Necrotic bone removal and autologous bone grafting procedures (light bulb technique) through minimally invasive open and arthroscopic fashion have become increasingly popular with patients and doctors for treating ONFH (5)(6)(7).…”