Fast-tracking for total knee replacement reduces use of institutional care without compromising quality

Abstract

Background and purposeFast-tracking shortens the length of the primary treatment period (length of stay, LOS) after total knee replacement (TKR). We evaluated the influence of the fast-track concept on the length of uninterrupted institutional care (LUIC) and other outcomes after TKR.Patients and methods4,256 TKRs performed in 4 hospitals between 2009–2010 and 2012–2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified as fast track (Hospital A) and non-fast track (Hospitals B, C and D). We analyzed length of uninterrupted institutional care (LUIC), LOS, discharge destination, readmission, revision, manipulation under anesthesia (MUA) and mortality rate in each hospital. We compared these outcomes for TKRs performed in Hospital A before and after fast-track implementation and we also compared Hospital A outcomes with the corresponding outcomes for the other 3 hospitals.ResultsAfter fast-track implementation, median LOS in Hospital A fell from 5 to 3 days (p < 0.001) and (median) LUIC from 7 to 3 (p < 0.001) days. These reductions in LOS and LUIC were accompanied by an increase in the discharge rate to home (p = 0.01). Fast-tracking in Hospital A led to no increase in 14- and 42-day readmissions, MUA, revision or mortality compared with the rates before fast-tracking, or with those in the other hospitals. Of the 4 hospitals, LOS and LUIC were most reduced in Hospital A.InterpretationA fast-track protocol reduces LUIC and LOS after TKR without increasing readmission, complication or revision rates.

Reasons and Risk Factors for Delayed Discharge After Total Knee Arthroplasty Using an Opioid-Sparing Discharge Protocol

“…The median LOS was 3 days, which is similar to what has been reported in the recent literature [1,3,5,6,10]. A few studies report a median LOS of 2 days [7,15].…”

Manipulation under anesthesia after primary knee arthroplasty in Sweden: incidence, patient characteristics and risk of revision

“…2015, Pamilo et al. 2018) included patients operated with TKA during the same time period as the patients in our study, but in fast-track hospitals. These studies showed an incidence of MUA of almost 6%, which was comparable to the hospital in Sweden with the highest incidence (5%).…”

“…A Finnish study reported on the incidence of MUA in 1 hospital during the first 6 months after the primary knee arthroplasty surgery, before and after implementing fast-track (Pamilo et al. 2018). They found a similar incidence before (2009–2010) and after (2012–2013) fast-track (6%).…”

The effect of pre-operative high doses of methylprednisolone on pain management and convalescence after total hip replacement in elderly: a double-blind randomized study

“…The surgical incision, as a mechanical factor, affects the nociceptor, initiates the pain process, and triggers numerous inflammatory mediators [1,4,5]. The Enhanced Recovery After Surgery (ERAS) with the method multimodal analgesia accelerates the patient's returning to full activity [4][5][6][7][8][9][10] and limits the complications and time of hospitalization [9][10][11][12][13][14]. Of interest is whether ERAS protocol is effective in the group patients older than 65 years, who more commonly suffer from concomitants diseases and whose comorbidities are more advanced; the physiological functional reserve is decidedly lower due to systemic involution [10][11][12][13]15].…”