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Readmissions after fast-track hip and knee arthroplasty
Henrik Husted1, Kristian Stahl Otte, Billy B Kristensen
1Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark. henrikhusted@dadlnet.dk
Archives of Orthopaedic and Trauma Surgery
|June 11, 2010
Summary
Fast-track surgery for total hip (THA) and knee (TKA) arthroplasty reduces hospital stay without increasing readmissions. While TKA has higher readmissions than THA, risks of dislocation and manipulation do not rise with shorter lengths of stay.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Patient Recovery Protocols
Background:
- Fast-track surgery protocols optimize logistical and clinical aspects of patient care.
- Reduced length of stay (LOS) in fast-track programs aims for earlier functional recovery.
- Concerns exist regarding potential increases in readmissions with shorter LOS, particularly for complications like dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA).
Purpose of the Study:
- To evaluate the impact of fast-track surgery on readmission rates after primary THA and TKA.
- To determine if decreasing LOS is associated with an increased risk of specific complications such as dislocation or manipulation.
- To compare readmission rates between THA and TKA procedures within a fast-track setting.
Main Methods:
- A cohort of 1,731 consecutive patients undergoing primary THA or TKA within a standardized fast-track surgical setup (2004-2008) was analyzed.
- Readmissions and deaths within 90 days post-surgery were tracked using the national health register.
- Data on LOS, readmission causes, and specific complications were collected and analyzed in relation to LOS duration.
Main Results:
- Mean LOS significantly decreased from 6.3 to 3.1 days.
- Overall 90-day readmission rates were 15.6% for TKA and 10.9% for THA (p = 0.005).
- Readmissions for thromboembolic events, dislocations, and manipulations did not increase with decreasing LOS; dislocation risk actually decreased with shorter LOS over the study period.
Conclusions:
- Fast-track protocols for THA and TKA are not associated with an increased overall readmission rate.
- While TKA procedures exhibit higher readmission rates compared to THA, the risk of dislocation after THA and manipulation after TKA does not escalate as LOS is reduced.
- The findings support the safety and efficacy of fast-track arthroplasty in reducing hospital stay without compromising patient safety regarding key complications.
