Georgios I Drosos1, Ioannis E Kougioumtzis2, Stylianos Tottas2, Athanasios Ververidis3, Christos Chatzipapas4, Grigorios Tripsianis5, Konstantinos Tilkeridis3. 1. Chairman of Academic Department of Orthopaedic Surgery, Faculty of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece. 2. University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece. 3. Faculty of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece. 4. Director of Orthopeadic Department at 492 General Military Hospital of Alexandroupolis, Academic Fellow at the University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece. 5. Department of Medical Statistics, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, PO Box 68100, Greece.
Abstract
BACKGROUND: Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department. MATERIAL AND METHODS: This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recorded (i.e. respectively Patients' demographics, ASA classification, Charlson index, LOS, blood loss, transfusion rate, complications and 30 - day readmissions). RESULTS: Four hundred and thirty four patients underwent either TKR (n: 302) or THR (n:132) and were included in this study. A gradual reduction of mean LOS was found in THR patients from 5.7 days to 3.0 days and in TKR patients from 5.6 days to 3.4 days. Furthermore, no significant difference was found in complications or regarding the 30-day readmission rate at the different stages of implementation of the different FT components (i.e. at the final stage 96.7% of THR and 86.7% of TKR patients were discharged to home by the fourth post-operative day). CONCLUSION: The stepwise implementation of a FT program in an unelected population of THR and TKR patients was effective and safe, reducing the post-surgical recovery time and patients' LOS with no major complications and no increase of 30-day re-admissions.
BACKGROUND: Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department. MATERIAL AND METHODS: This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recorded (i.e. respectively Patients' demographics, ASA classification, Charlson index, LOS, blood loss, transfusion rate, complications and 30 - day readmissions). RESULTS: Four hundred and thirty four patients underwent either TKR (n: 302) or THR (n:132) and were included in this study. A gradual reduction of mean LOS was found in THR patients from 5.7 days to 3.0 days and in TKR patients from 5.6 days to 3.4 days. Furthermore, no significant difference was found in complications or regarding the 30-day readmission rate at the different stages of implementation of the different FT components (i.e. at the final stage 96.7% of THR and 86.7% of TKR patients were discharged to home by the fourth post-operative day). CONCLUSION: The stepwise implementation of a FT program in an unelected population of THR and TKR patients was effective and safe, reducing the post-surgical recovery time and patients' LOS with no major complications and no increase of 30-day re-admissions.
Authors: Nicholas Christelis; Sophie Wallace; Claire E Sage; Uate Babitu; Susan Liew; James Dugal; Ibolya Nyulasi; Nora Mutalima; Ton Tran; Paul S Myles Journal: Med J Aust Date: 2015-04-20 Impact factor: 7.738
Authors: Nina M C Mathijssen; Hennie Verburg; Carsten C G van Leeuwen; Tim L Molenaar; Gerjon Hannink Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-12-19 Impact factor: 4.342
Authors: Daniel R Whiting; Blake P Gillette; Christopher Duncan; Hugh Smith; Mark W Pagnano; Rafael J Sierra Journal: Clin Orthop Relat Res Date: 2014-01 Impact factor: 4.176