Assessment of Fast-Track Pathway in Hip and Knee Replacement Surgery by Propensity Score Matching on Patient-Reported
Andrea Campagner1, Frida Milella1, Stefania Guida1
1IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy.
Diagnostics (Basel, Switzerland)
|March 29, 2023
Summary
Fast Track (FT) surgery significantly improves physical health outcomes for hip and knee replacement patients compared to standard care. This coordinated approach enhances patient-reported physical health status three months post-surgery.
Area of Science:
- Orthopedic Surgery
- Rehabilitation Medicine
- Health Services Research
Background:
- Total hip (THA) and total knee (TKA) arthroplasty procedures are increasing, necessitating cost-effective strategies for rapid recovery and improved patient outcomes.
- Fast Track (FT) surgical procedures offer a coordinated perioperative approach to expedite recovery, shorten hospital stays, and reduce costs.
- Evidence-based practices are crucial for optimizing traditional rehabilitation methods in rapid recovery surgery.
Purpose of the Study:
- To compare the effectiveness of Fast Track (FT) versus Care-as-Usual (CAU) surgical pathways on mid-term patient-reported outcomes (PROs) after hip or knee replacement.
- To evaluate the impact of the entire FT pathway, including postoperative rehabilitation, on physical and mental health scores (SF-12) at 3 months post-surgery.
- To address group comparability in a non-randomized study using Propensity Score Matching (PSM) analysis.
Main Methods:
- A Propensity Score Matching (PSM) analysis was employed to compare patients undergoing FT and CAU pathways for THA and TKA.
- Early home discharge was used as a surrogate to differentiate between FT and CAU rehabilitation pathways.
- Patient-reported outcomes (PROs), specifically the SF-12 Physical and Mental Component Scores, were assessed at 3 months post-surgery.
Main Results:
- The FT pathway demonstrated a significantly positive impact on physical health-related status (SF-12 Physical Scores) at 3 months post-hip or knee replacement.
- Patients in the FT group reported significantly better PROs and relative improvements compared to the minimum clinically important difference.
- No significant difference was observed in the Mental Component Scores between the FT and CAU groups.
Conclusions:
- The comprehensive Fast Track pathway, encompassing postoperative rehabilitation, significantly enhances physical health status for patients undergoing hip or knee arthroplasty.
- FT rehabilitation positively influences patient-reported physical health outcomes, supporting its adoption for improved recovery.
- Further research is warranted to explore the effects of FT rehabilitation on the overall care process and long-term PROs in arthroplasty patients.
