Days alive and out of hospital after fast-track total hip and knee arthroplasty: an observational cohort study in 16 137 patients

Christoffer C. Jørgensen*, Pelle B. Petersen, Henrik Kehlet, Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group, Christoffer C. Jørgensen (Medlem af forfattergruppering), Pelle B Petersen (Medlem af forfattergruppering), Henrik Kehlet (Medlem af forfattergruppering), Frank Madsen (Medlem af forfattergruppering), Torben B. Hansen (Medlem af forfattergruppering), Henrik Husted (Medlem af forfattergruppering), Mogens Laursen (Medlem af forfattergruppering), Lars T. Hansen (Medlem af forfattergruppering), Per Kjærsgaard-Andersen (Medlem af forfattergruppering), Søren Solgaard (Medlem af forfattergruppering), Lars Peter Jorn (Medlem af forfattergruppering)

*Kontaktforfatter

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

20 Citationer (Scopus)

Abstract

Background: Days alive and out of hospital (DAH) has been proposed as a pragmatic outcome measure of surgical quality. However, there is a lack of procedure specific data or data within an optimised fast-track protocol. Furthermore, information about influence of follow-up duration and types of complications on DAH is limited. Methods: Observational multicentre cohort study of patients undergoing fast-track total hip (THA) and knee arthroplasty (TKA). Prospective information on comorbidity and complete 90 days follow-up was undertaken through the Danish National Patient Register and chart review. Results: For 16 137 procedures, of which 18.6% were high-risk (≥2 preoperative risk factors), the median length of stay was 2 days (inter-quartile range [IQR], 2–3), and 30- and 90-day readmission rates were 5.7% and 8.1%, respectively. Median DAH30 and DAH90 days were 27 (26–28) and 87 (85–88) vs 28 (27–28) and 88 (87–89) (P<0.001) in high-vs low-risk patients, respectively. The fraction with DAH ≤25 at 30 days and DAH ≤85 at 90 days was increased in high-vs low-risk patients: 23.3% vs 6.8% (odds ratio [OR]=4.16; 95% confidence interval [CI], 3.73–4.65) and 26.0% vs 8.6% (OR=3.75; 95% CI, 3.38–4.16). There were relatively fewer ‘surgical’ complications in high- vs low-risk patients with DAH30 ≤25 (14.6% vs 25.8%) (OR=0.49; 95% CI, 0.37–0.65) and DAH90 ≤85 (16.9% vs 31.89%) (OR=0.43; 95% CI, 0.34–0.56). About 2% of patients had readmissions, but DAH was >25 and >85 at 30 and 90 days after operation, respectively. Conclusion: Median DAH in fast-track THA/TKA patients is 28 at 30 days and 88 at 90 days after surgery. DAH in high-risk patients was only slightly reduced compared with low-risk patients, but they have relatively more ‘medical’ complications.

OriginalsprogEngelsk
TidsskriftBritish Journal of Anaesthesia
Vol/bind123
Udgave nummer5
Sider (fra-til)671-678
Antal sider8
ISSN0007-0912
DOI
StatusUdgivet - nov. 2019

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