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Is Rapid Recovery Hip and Knee Replacement Possible and Safe in the Octogenarian Patient?
Paul K Edwards1, James R Kee1, Simon C Mears1
1Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Background:
Rapid recovery programs are now aimed to reduce costs of hip and knee arthroplasties by discharging patients directly home, shortening hospital length of stay (LOS), and reducing readmission rates. Although patients aged 80 years and older are included in the Medicare bundle, little work has been performed to determine if older patients can safely participate in rapid recovery programs.
Methods:
We retrospectively reviewed 2482 patients undergoing primary and revision total hip and knee arthroplasties (THA and TKA) who all participated in a multifaceted rapid recovery program. The goals of this program were next day discharge to home without the use of home services or post-acute care admission. We examined the hospital LOS and the percentage of patients discharged home as well as 90-day readmission rates to determine efficacy and safety of this program in the patients aged 80 years and older.
Results:
Octogenarians receiving primary THA and TKA were discharged home >90% of the time with LOSs <2 days and low readmission rates. Revision THA and TKA patients aged 80 years and older were discharged home about 70% of the time with significantly longer LOSs than patients aged more than 80 years. The revision THA patients aged more than 80 years had the highest readmission rates.
Conclusion:
Patients aged more than 80 years can successfully and safely participate in rapid recovery programs.
