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Multicenter Study
. 2020 Dec 4;10(1):21233.
doi: 10.1038/s41598-020-77127-6.

Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017

Pelle Baggesgaard Petersen  1 , Henrik Kehlet  2   3 , Christoffer Calov Jørgensen  2   3 ; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group
Collaborators, Affiliations
Multicenter Study

Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017

Pelle Baggesgaard Petersen et al. Sci Rep. .

Abstract

"Fast-track" protocols has improved surgical care with a reduction in length of hospital stay (LOS) in total hip (THA) and knee arthroplasty (TKA). However, the effects of continuous refinement of perioperative care lack detailed assessment. We studied time-related changes in LOS and morbidity after THA and TKA within a collaboration with continuous scientific refinement of perioperative care. Prospective multicentre consecutive cohort study between 2010 and 2017 from nine high-volume orthopaedic centres with established fast-track THA and TKA protocols. Prospective collection of comorbidities and complete 90-day follow-up from the Danish National Patient Registry and medical records. Of 36,935 procedures median age was 69 [62 to 75] years and 58% women. LOS declined from three [two to three] days in 2010 to one [one to two] day in 2017. LOS > 4 days due to "medical" or "surgical" complications, and "with no recorded morbidity" declined from 4.4 to 2.7%, 1.5 to 0.6%, and 3.8 to 1.3%, respectively. 90-days readmission rate declined from 8.6 to 7.7%. Our multicentre study in a socialized healthcare setting was associated with a continuous reduction in LOS and morbidity after THA and TKA.

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Conflict of interest statement

PBP received an unconditional PhD grant from The Lundbeck Foundation [R230-2017-166] which took no part in study design, collection, analysis or interpretation of data, writing the report or the decision to submit the report for publication; HK is advisory board member at “Rapid Recovery” by Zimmer Biomet, outside the submitted work; CCJ has nothing to disclose.

Figures

Figure 1
Figure 1
Flowchart of study population. DNPR Danish National Patient Registry, THA total hip arthroplasty, TKA total knee arthroplasty.
Figure 2
Figure 2
Temporal trends in length of stay (LOS), readmissions and mortality from 2010–2017 in 36,935 fast-track THA and TKAs. (a) Mean and median LOS, (b) proportion of procedures with LOS > 4 days, 90-day readmission and mortality rate, (c) proportion of procedures with “surgical”-, “medical”-. and no recorded morbidity as reason for LOS > 4 days, (d) readmissions due to “surgical”-, “medical”-, and disproven complications. Figure created using R (R: A Language and Environment for Statistical Computing, Version 3.6.1; 2019) and ggplot (ggplot2: Elegant Graphics for Data Analysis, version 3.3.0, 2016).
Figure 3
Figure 3
Temporal trends in specific causes for LOS > 4 days in 36,935 fast-track THA and TKAs. (a) “surgical” causes; (b) “medical” causes. Figure created using R (R: A Language and Environment for Statistical Computing, Version 3.6.1; 2019) and ggplot (ggplot2: Elegant Graphics for Data Analysis, version 3.3.0, 2016).
Figure 4
Figure 4
Temporal trends in specific causes for 90-day readmission in 36,935 fast-track THA and TKA. (a) “surgical” causes; (b) “medical” causes. Figure created using R (R: A Language and Environment for Statistical Computing, Version 3.6.1; 2019) and ggplot (ggplot2: Elegant Graphics for Data Analysis, version 3.3.0, 2016).
Figure 5
Figure 5
Temporal trends of preoperative characteristics of 36,935 fast-track THA and TKA procedures. (a) Median age and BMI; (b) preoperative comorbidities; potent anticoagulants: preoperative vitamin-k antagonists and direct oral anticoagulant. Figure created using R (R: A Language and Environment for Statistical Computing, Version 3.6.1; 2019) and ggplot (ggplot2: Elegant Graphics for Data Analysis, version 3.3.0, 2016).
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References

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