Hip arthroplasty patients benefit from accelerated perioperative care and rehabilitation: A quasi-experimental study of 98 patients

Larsen, Kristian; Hansen, Torben Bæk; Søballe, Kjeld

doi:10.1080/17453670810016632

Cited by 48 publications

(52 citation statements)

References 15 publications

(12 reference statements)

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“…Our results demonstrate that this kind of fast-track program with a LOS of 24 hours is safe, and that this time-based patient-centered program appears to be in line with other fast-track THA—and does not compromise the quality of treatment or patient satisfaction (Larsen et al. 2008). In our cohort, we found only 1 DVT as a non-surgical complication.…”

Section: Discussionmentioning

confidence: 99%

24 hours stay after hip replacement

Eeden

Turck

Eeden³

2016

Acta Orthopaedica

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Background and purpose — The length of stay after total hip arthroplasty has been reduced to 2–4 days after implementing fast-track surgery. We investigated whether a new time-based patient-centered primary direct anterior approach (DAA) total hip arthroplasty (THA) treatment protocol in a specialized clinic, with a planned length of stay of about 24 hours, could be achieved in all patients or only in a selected group of patients.Patients and methods — We analyzed prospectively collected data in a cohort of 378 consecutive patients who underwent a primary direct anterior THA as a patient-centered time-based procedure between March 1, 2012 and December 31, 2015. Patients with complicated medical comorbidity and those over the age of 85 were excluded from the study. The average length of stay was recorded and all complications, re-admissions, and reoperations were registered and analyzed. The primary outcome measures were length of stay and complication rate, at discharge and 90 days postoperatively.Results — The average length of stay for all patients was 26 hours. All patients were discharged from the clinic on the day after the operation and were able to continue their recovery at home or in a rehabilitation facility. The overall complication rate within 3 months of surgery was 6%. The 3-month re-admission rate and the 3-month reoperation rate were both 2%.Interpretation — Performing a time-based, patient-centered fast-track program for DAA total hip arthroplasty can result in a standardized length of stay of about 24 hours and a high level of patient satisfaction with few complications, re-admissions, and reoperations.

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Section: Discussionmentioning

confidence: 99%

24 hours stay after hip replacement

Eeden

Turck

Eeden³

2016

Acta Orthopaedica

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“…Compared to conventional hip and knee surgery, fast-track hip and knee surgery focuses on optimising pain management, achieving early mobilisation, early start of training and early discharge to home reducing the length of stay in hospital without risk of an increased number of complications and readmissions (Larsen, Hansen, & Soballe, 2008a;Larsen, Hvass, Hansen, Thomsen, & Soballe, 2008b;Larsen, Sorensen, Hansen, Thomsen, & Soballe, 2008c), Early training is rehabilitation carried out in activities of daily living by occupational therapists (OTs), walking with crutches and muscle strength training by physiotherapists (PTs), Furthermore, fast-track hip and knee surgery seems to reduce the risk postoperative delirium (Krenk et al,, 2012) and possibly also thromboembolic events (Husted et al,, 2010), In addition to optimising pain management, achieving early mobilisation and training, dizziness, general weakness, nausea, vomiting and confusion also contribute to the length of stay in hospital after knee and hip replacement (Husted et al,, 2011), Interprofessional rounds have been used for many years assembling team members in a single location, and the use of these meetings has been associated with lover mortality among intensive care unit patients (O'Leary, Sehgal, Terrell, & Williams, 2011), Likewise, it has been demonstrated that interprofessional structured team briefings Correspondence: Torben Bíek Han,sen, MD, PhD, University of Aarhus, The Lundbeek Center for Fast Track Hip and Knee Surgery, Laegaardvej 12, Entrance N, 7500, Denmark, E-mail: torbehns@rm,dk reduces the number of communication failures and promotes proactive and collaborative team communication (Lingard et al,, 2008), So to achieve fast-track surgery, interprofessional collaboration between all involved professions is imperative.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional collaboration may pay off: introducing a collaborative approach in an orthopaedic ward

Pape

Thiessen

Jakobsen

et al. 2013

Journal of Interprofessional Care

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Fast-track hip and knee surgery focuses on optimising pain management, achieving early mobilisation and shortening the length of stay in hospital. These factors make interprofessional collaboration imperative. With the aim of further diminishing the length of stay for patients admitted to an orthopaedic ward for hip or knee replacement and with inspiration from an interprofessional training unit, a daily interprofessional meeting was introduced. At this interprofessional meeting, surgeons, nurses, occupational therapists and physiotherapists used a checklist in discussing barriers and focus areas for discharging hip and knee replacement patients and made joint decisions about which healthcare profession should handle a given task. This interprofessional collaboration was tested in a case control study comparing hospital length of stay in 75 patients treated before introduction of the daily interprofessional meeting with 88 patients treated after the introduction. The result was a significant reduction in the length of stay in hospital in total hip replacement patients (from a mean of 4.1 days (SD 2.1) to 2.7 days (SD 1.4), p < 0.05) but not in knee replacement patients (from a mean of 3.7 days (SD 1.9) to 3.1 days (SD 1.6), p = 0.33). So improving interprofessional collaboration by introducing an interprofessional daily meeting may reduce the length of stay in hospital for total hip replacement patients, but further studies are needed to explore the effect in knee replacement patients.

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“…LOS cannot be regarded as a single primary outcome (Larsen et al. 2008), but must be seen in relation to other outcome measures. To emphasize the importance of maintaining quality of treatment, we selected HRQoL as a primary outcome together with LOS.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine support shortens length of stay after fast-track hip replacement

et al. 2016

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Background and purpose — Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement.Patients and methods — We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery.Results — Length of stay was reduced from 2.1 days (95% CI: 2.0–2.3) to 1.1 day (CI: 0.9–1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group.Interpretation — Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement.

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Hip arthroplasty patients benefit from accelerated perioperative care and rehabilitation: A quasi-experimental study of 98 patients

Cited by 48 publications

References 15 publications

24 hours stay after hip replacement

24 hours stay after hip replacement

Interprofessional collaboration may pay off: introducing a collaborative approach in an orthopaedic ward

Telemedicine support shortens length of stay after fast-track hip replacement

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