Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017

• Published in: Scientific reports Vol. 10; no. 1; p. 21233
• Main Authors: Petersen, Pelle Baggesgaard, Kehlet, Henrik, Jørgensen, Christoffer Calov
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 04.12.2020; Nature Publishing Group
• Subjects: 692/308; 692/308/409; 692/4023/1670/407; 692/700; Aged; Arthroplasty (hip); Arthroplasty (knee); Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - history; Arthroplasty, Replacement, Hip - mortality; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - history; Arthroplasty, Replacement, Knee - mortality; Cohort Studies; Female; Hip; History, 21st Century; Humanities and Social Sciences; Humans; Joint replacement surgery; Joint surgery; Length of Stay - statistics & numerical data; Male; Medical records; Middle Aged; Morbidity; multidisciplinary; Observational Studies as Topic; Patient Readmission - statistics & numerical data; Perioperative care; Postoperative Complications - etiology; Prospective Studies; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-77127-6

“Fast-track” protocols has improved surgical care with a reduction in length of hospital stay (LOS) in total hip (THA) and knee arthroplasty (TKA). However, the effects of continuous refinement of perioperative care lack detailed assessment. We studied time-related changes in LOS and morbidity after THA and TKA within a collaboration with continuous scientific refinement of perioperative care. Prospective multicentre consecutive cohort study between 2010 and 2017 from nine high-volume orthopaedic centres with established fast-track THA and TKA protocols. Prospective collection of comorbidities and complete 90-day follow-up from the Danish National Patient Registry and medical records. Of 36,935 procedures median age was 69 [62 to 75] years and 58% women. LOS declined from three [two to three] days in 2010 to one [one to two] day in 2017. LOS > 4 days due to “medical” or “surgical” complications, and “with no recorded morbidity” declined from 4.4 to 2.7%, 1.5 to 0.6%, and 3.8 to 1.3%, respectively. 90-days readmission rate declined from 8.6 to 7.7%. Our multicentre study in a socialized healthcare setting was associated with a continuous reduction in LOS and morbidity after THA and TKA.