Care principles at four fast-track arthroplasty departments in Denmark

The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery.

Based on the National Patient Registry's information on patients who have undergone total hip and knee arthroplasty, four departments were chosen for evaluation in accordance with the following inclusion criteria: documented fast-track surgery with written care plans, a surgical volume of > 450 arthroplasties and short length of stay (LOS) (< 5 days).

The mean LOS ranged from 2.8 to 3.9 days. Logistic features included homogeneous entities, regular staff, high level of continuity, preoperative information including intended LOS, admission on the day of surgery and functional discharge criteria. The clinical features were both intraoperative (spinal anaesthesia, local infiltration analgesia, plans for fluid therapy, small standard incisions, no drains, compression bandages and cooling) and postoperative (deep venous thrombosis prophylaxis starting 6-8 hours postoperatively, multimodal opioid-sparing analgesia, early mobilisation and discharge when functional criteria were met) facilitating early rehabilitation and discharge.

The logistic set-up at the four departments was almost identical. The basic care prerequisites to pooling the patients from these four departments were in place. Future studies will include outcomes as well as safety aspects of this set-up.