Patient satisfaction in fast-track limb lengthening and realignment surgery

We investigated whether an accelerated protocol could reduce length of stay (LOS) in reconstructive orthopaedic surgery. Procedures included limb lengthening, limb alignment corrections and hardware removals. Patient satisfaction was evaluated using patient-reported outcome measures (PROMs). Possible cost savings were estimated.

A total of 26 patients scheduled for 34 elective procedures were included, comprising intramedullary limb lengthening (n = 6), osteotomies (n = 13) and hardware removals (n = 15). Outcomes included LOS, short-term complications and PROMs-based satisfaction. LOS was compared with LOS in a historic cohort (n = 11).

Same-day discharge was achieved in 19 of 22 planned cases (87%). Eight of 12 cases (67%) planned for discharge on the day after surgery achieved the goal. Seven cases required 1-4 unplanned nights of hospitalisation, four following plating osteotomies, one external ring fixation, one motorised intramedullary limb lengthening implementation and one hardware removal. Reasons for delayed discharge included pain (n = 5), desaturation (n = 1) and anticoagulant issues (n = 1). Average LOS was 1.1 days compared with 4.4 days in the historic cohort. PROMs indicated high satisfaction, with 16 of 22 patients reporting an excellent or very good overall experience. Direct cost savings were approximately 1,000 euros per night saved.

Fast-track protocols in reconstructive surgery can substantially reduce LOS and are associated with high patient satisfaction. Patients with pre-existing pain issues or patients undergoing tibial procedures may require additional support.

None.

Study permission: R-24053042 rh dk.