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

• Published in: Acta orthopaedica Vol. 88; no. 1; pp. 41 - 47
• Main Authors: Vesterby, Martin Svoldgaard, Pedersen, Preben Ulrich, Laursen, Malene, Mikkelsen, Søren, Larsen, Jens, Søballe, Kjeld, Jørgensen, Lene Bastrup
• Format: Journal Article
• Language: English
• Published: England 01.02.2017
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - methods; Early Ambulation - methods; Female; Follow-Up Studies; Humans; Length of Stay - trends; Male; Middle Aged; Quality of Life; Retrospective Studies; Telemedicine; Time Factors
• ISSN: 1745-3682
• DOI: 10.1080/17453674.2016.1256939

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.