The results of a stepwise implementation of a fast-track program in total hip and knee replacement patients.
Enhanced recovery after surgery
Fast-track
Total hip arthroplasty
Total knee arthroplasty
Journal
Journal of orthopaedics
ISSN: 0972-978X
Titre abrégé: J Orthop
Pays: India
ID NLM: 101233220
Informations de publication
Date de publication:
Historique:
received:
21
02
2020
accepted:
23
03
2020
entrez:
8
4
2020
pubmed:
8
4
2020
medline:
8
4
2020
Statut:
epublish
Résumé
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. 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). 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). 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 32255989
doi: 10.1016/j.jor.2020.03.004
pii: S0972-978X(20)30088-X
pmc: PMC7114635
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100-108Informations de copyright
© 2020 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.
Déclaration de conflit d'intérêts
Authors declare that they have no conflict of interest.
Références
Knee Surg Sports Traumatol Arthrosc. 2016 Aug;24(8):2692-6
pubmed: 26685683
Lancet. 2013 May 11;381(9878):1600-2
pubmed: 23663938
Eur J Orthop Surg Traumatol. 2015 Jul;25(5):871-5
pubmed: 25633124
Transfusion. 2014 Mar;54(3):717-26
pubmed: 23829298
Med J Aust. 2015 Apr 20;202(7):363-8
pubmed: 25877118
Rev Esp Cir Ortop Traumatol. 2017 Mar - Apr;61(2):111-116
pubmed: 28073671
Clin Orthop Relat Res. 2014 Jan;472(1):66-72
pubmed: 23817754
Anesthesiology. 1978 Oct;49(4):239-43
pubmed: 697077
BMC Med. 2013 Feb 13;11:37
pubmed: 23406499
Acta Orthop. 2013 Feb;84(1):40-3
pubmed: 23368747
J Bone Joint Surg Am. 2014 Feb 19;96(4):272-8
pubmed: 24553882
J Arthroplasty. 2017 Mar;32(3):714-718
pubmed: 27776899
Bull Hosp Jt Dis (2013). 2013;71(3):222-6
pubmed: 24151950
Br J Anaesth. 1997 May;78(5):606-17
pubmed: 9175983
Br J Anaesth. 2003 Dec;91(6):830-5
pubmed: 14633754
Can J Anaesth. 2011 Oct;58(10):891-4, 894-6
pubmed: 21833818
Lancet. 2003 Dec 6;362(9399):1921-8
pubmed: 14667752
Curr Opin Rheumatol. 2003 Mar;15(2):160-2
pubmed: 12598806
Acta Orthop. 2015 Feb;86(1):78-85
pubmed: 25175663
Acta Orthop. 2011 Dec;82(6):679-84
pubmed: 22066560
Acta Orthop. 2008 Apr;79(2):174-83
pubmed: 18484242
Bone Joint J. 2016 Apr;98-B(4):475-82
pubmed: 27037429
Acta Orthop. 2008 Apr;79(2):149-59
pubmed: 18478482
J Bone Joint Surg Am. 2007 Jan;89(1):27-32
pubmed: 17200306
J Arthroplasty. 2016 Jan;31(1):11-4
pubmed: 26346704
Med J Aust. 1999 Jan 18;170(2):59-62
pubmed: 10026684
Br J Anaesth. 2014 Sep;113(3):360-74
pubmed: 24939863
Arch Phys Med Rehabil. 2012 Jul;93(7):1292-4
pubmed: 22494947
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3585-3595
pubmed: 27417102
Open Orthop J. 2011 Mar 16;5:80-5
pubmed: 21584277
Ann Surg. 2008 Aug;248(2):189-98
pubmed: 18650627
Acta Orthop. 2008 Apr;79(2):168-73
pubmed: 18484241
Can J Anaesth. 2011 Oct;58(10):902-10
pubmed: 21822756
Arch Orthop Trauma Surg. 2009 Dec;129(12):1585-91
pubmed: 19198860
J Bone Joint Surg Am. 2007 Apr;89(4):780-5
pubmed: 17403800
J Arthroplasty. 2016 Aug;31(8):1686-1692.e1
pubmed: 26968693
Acta Orthop. 2010 Jun;81(3):271-2
pubmed: 20446827
BMJ. 2014 Aug 12;349:g4829
pubmed: 25116268
Arch Orthop Trauma Surg. 2012 Jan;132(1):101-4
pubmed: 21947286
Medicine (Baltimore). 2016 Sep;95(36):e4689
pubmed: 27603364
Clin Orthop Relat Res. 2015 Nov;473(11):3446-55
pubmed: 25845947
Clin Rehabil. 2015 Sep;29(9):844-54
pubmed: 25452634
ANZ J Surg. 2016 Jun;86(6):475-9
pubmed: 27018137
Orthop Traumatol Surg Res. 2012 Sep;98(5):499-505
pubmed: 22796251
J Orthop. 2016 Mar 26;13(3):127-31
pubmed: 27222617
Eur J Anaesthesiol. 2016 Nov;33(11):816-831
pubmed: 27428259
Dan Med Bull. 2010 Jul;57(7):A4166
pubmed: 20591341
J Arthroplasty. 2018 Jun;33(6):1675-1680
pubmed: 29478678
Injury. 2006 Dec;37 Suppl 5:S31-5
pubmed: 17338910
Rev Esp Cir Ortop Traumatol. 2017 Mar - Apr;61(2):130-138
pubmed: 28233658
Acta Orthop. 2014 Feb;85(1):26-31
pubmed: 24359028
Arch Orthop Trauma Surg. 2010 Feb;130(2):263-8
pubmed: 19633865
Arch Orthop Trauma Surg. 2013 Jan;133(1):117-24
pubmed: 23070220
Clin Orthop Relat Res. 2009 Jun;467(6):1418-23
pubmed: 19214642
J Arthroplasty. 2016 Oct;31(10):2227-30
pubmed: 27209333
Postgrad Med J. 2017 Dec;93(1106):736-742
pubmed: 28751437
Nurs Stand. 2009 Nov 4-10;24(9):18-9
pubmed: 19953760
J Bone Joint Surg Am. 2004 May;86(5):963-74
pubmed: 15118039
J Arthroplasty. 2015 Feb;30(2):272-6
pubmed: 25257237
Br J Anaesth. 2011 Mar;106(3):289-91
pubmed: 21317226
Acta Orthop. 2011 Oct;82(5):577-81
pubmed: 21895500
Br J Anaesth. 2016 Dec;117(suppl 3):iii62-iii72
pubmed: 27940457