Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011–2015: an observational study including 51,169 THR and 8,393 TKR operations

Abstract

Background and purpose — Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers. Patients and methods — Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011–2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS. Results — The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens’ d formula were < 0.2 for all PROs, in both THR and TKR. Interpretation — Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

“…Like other trials 7,12,13 , we did not nd any difference between groups on PROMs 9 months or later after surgery. Berg et al 10 did discover slightly better PROMs in its fast-track cohort at 1 year. However, this difference was not clinically signi cant and multiple cofounders might explain their results, thus limiting the validity of their ndings.…”

“…To our knowledge, no other studies reported lasting effects of ERAS procedures regarding the time needed to regain important functional abilities. Yet, some studies did nd better PROMs in the rst few months, 9,10,11 supporting the possible superiority of ERAS interventions on recovery in the acute and subacute postoperative period. However, the bene ts of ERAS procedures seemed to vanish with time.…”

“…Some studies suggested that immediate postoperative pain was better controlled by ERAS interventions 2,7 while others found no difference. 3 8 Some studies showed faster recovery in the rst few days 7 and better functional outcomes 3-6-12 months after surgery 9,10,11 while others found no difference at all. 12,13 Improved patient satisfaction regarding the fast track pathway is also controversial.…”

Effect of Observation of Shou Hui Tong Bian Capsule (Polygonum Multiflorum and Aloe-Based Herbal Capsule for Cathartic Effect) in Rapid Rehabilitation of Joint Surgery

“… Inclusion Criteria . (1) Age: 45–75 years; (2) Meets the relevant criteria of postoperative gastrointestinal dysfunction and “PI syndrome” (postinfectious irritable bowel syndrome) in the Guiding Principles for Clinical Research on New Drugs of Traditional Chinese Medicine [ 7 ]; (3) patients without surgical taboo; (4) patients with no abnormal blood test and liver and kidney function; (5) patients who signed informed consent and knew about the content of the study Exclusion Criteria . (1) Patients with previous gastrointestinal diseases; (2) recently taking drugs promoting gastrointestinal motility and drugs affecting electrolyte metabolism things; (3) autoimmune diseases that affect gastrointestinal motility, such as immunodeficiency.…”

“…Inclusion Criteria . (1) Age: 45–75 years; (2) Meets the relevant criteria of postoperative gastrointestinal dysfunction and “PI syndrome” (postinfectious irritable bowel syndrome) in the Guiding Principles for Clinical Research on New Drugs of Traditional Chinese Medicine [ 7 ]; (3) patients without surgical taboo; (4) patients with no abnormal blood test and liver and kidney function; (5) patients who signed informed consent and knew about the content of the study…”