The results of a stepwise implementation of a fast-track program in total hip and knee replacement patients

被引：9

作者：

Drosos, Georgios, I ^{[1
]}

Kougioumtzis, Ioannis E. ^{[2
]}

Tottas, Stylianos ^{[2
]}

Ververidis, Athanasios ^{[3
]}

Chatzipapas, Christos ^{[4
]}

Tripsianis, Grigorios ^{[5
]}

Tilkeridis, Konstantinos ^{[3
]}

机构：

[1] Democritus Univ Thrace, Univ Gen Hosp Alexandroupolis, Acad Dept Orthopaed Surg, Fac Med, POB 68100, Alexandroupolis, Greece

[2] Univ Gen Hosp Alexandroupolis, POB 68100, Alexandroupolis, Greece

[3] Democritus Univ Thrace, Univ Gen Hosp Alexandroupolis, Fac Med, POB 68100, Alexandroupolis, Greece

[4] Univ Gen Hosp Alexandroupolis, Gen Mil Hosp Alexandroupolis 492, Orthopead Dept, POB 68100, Alexandroupolis, Greece

[5] Democritus Univ Thrace, Fac Med, Dept Med Stat, POB 68100, Alexandroupolis, Greece

来源：

JOURNAL OF ORTHOPAEDICS | 2020年 / 21卷

关键词：

Total hip arthroplasty; Total knee arthroplasty; Fast-track; Enhanced recovery after surgery; LENGTH-OF-STAY; LOCAL INFILTRATION ANALGESIA; ENHANCED RECOVERY PROGRAM; TOTAL JOINT ARTHROPLASTY; TRANEXAMIC ACID USE; REDUCES LENGTH; HOSPITAL STAY; UNITED-STATES; ELECTIVE HIP; FOLLOW-UP;

D O I：

10.1016/j.jor.2020.03.004

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background: Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department. Material and methods: This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recorded (i.e. respectively Patients' demographics, ASA classification, Charlson index, LOS, blood loss, transfusion rate, complications and 30 day readmissions). Results: Four hundred and thirty four patients underwent either TKR (n: 302) or THR (n:132) and were included in this study. A gradual reduction of mean LOS was found in THR patients from 5.7 days to 3.0 days and in TKR patients from 5.6 days to 3.4 days. Furthermore, no significant difference was found in complications or regarding the 30-day readmission rate at the different stages of implementation of the different FT components (i.e. at the final stage 96.7% of THR and 86.7% of TKR patients were discharged to home by the fourth postoperative day). Conclusion: The stepwise implementation of a FT program in an unelected population of THR and TKR patients was effective and safe, reducing the post-surgical recovery time and patients' LOS with no major complications and no increase of 30-day re-admissions.

引用

页码：100 / 108

页数：9

共 63 条

[11] Implementation of a Total Hip Arthroplasty Care Pathway at a High-Volume Health System: Effect on Length of Stay, Discharge Disposition, and 90-Day Complications [J].