Fast-Track Total Hip, Knee Arthroplasty in Older People Cuts Length of Hospital Stay

By Reuters Staff

January 03, 2020

NEW YORK (Reuters Health) - The length of hospital stay (LOS) for older patients undergoing total hip or knee arthroplasty (THA/TKA) declined significantly over the past decade with the implementation of fast-track protocols, a new study shows.

"The results of this large detailed multicentre study in unselected THA/TKA patients aged >=85 years, showed a marked decrease in LOS from 4 days in 2010 to 2 days in 2017," Dr. Pelle Baggesgaard Petersen of Copenhagen University Hospital in Denmark and colleagues write in Age and Ageing.

"However, the unchanged readmission and mortality rates pose an important challenge for improvement and the goal of a 'pain and risk free' THA and TKA has not yet been achieved," they add.

Fast-track protocols are designed to improve recovery and reduce organ dysfunction after surgery, and some small studies have suggested they may be beneficial for older patients undergoing THA/TKA, the authors note.

They looked at 1,427 consecutive patients 85 and older who underwent THA/TKA in 2010-2017 at nine orthopedic centers in Denmark reporting to the Lundbeck Centre for Fast-track Hip and Knee Replacement database.

In addition to the 50% reduction in LOS, the percentage of patients with an LOS of more than four days fell from 32% to 18% over the study period. Readmission and mortality rates were 11.7% and 0.9% at 30 days and 16% and 1.5% at 90 days, respectively.

The findings show that the "major progress" made with fast-track protocols for THA/TKA extends to patients 85 and older, the authors note.

"However, the unchanged 90-day readmissions rate of about 16.0% poses an important area for further improvements," they conclude.

SOURCE: Age and Ageing, online December 23, 2019.