TY - JOUR
T1 - Fast-track revision hip arthroplasty
T2 - a multicenter cohort study on 1,345 elective aseptic major component revision hip arthroplasties
AU - Lindberg-Larsen, Martin
AU - Petersen, Pelle Baggesgaard
AU - Corap, Yasemin
AU - Gromov, Kirill
AU - Jørgensen, Christoffer Calov
AU - Kehlet, Henrik
AU - Centre for Fast-track Hip and Knee Replacement Collaborative Group
A2 - Solgaard, Søren
A2 - Beck, Torben
PY - 2022/2/23
Y1 - 2022/2/23
N2 - BACKGROUND AND PURPOSE: Data on application of fasttrack/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures.PATIENTS AND METHODS: This is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included.RESULTS: 1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2-6), decreasing from median 6 (IQR 3-10) days in 2010 to 2 (IQR 1-4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70-79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days).INTERPRETATION: LOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.
AB - BACKGROUND AND PURPOSE: Data on application of fasttrack/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures.PATIENTS AND METHODS: This is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included.RESULTS: 1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2-6), decreasing from median 6 (IQR 3-10) days in 2010 to 2 (IQR 1-4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70-79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days).INTERPRETATION: LOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.
KW - Aged
KW - Aged, 80 and over
KW - Arthroplasty, Replacement, Hip/adverse effects
KW - Arthroplasty, Replacement, Knee/adverse effects
KW - Cohort Studies
KW - Elective Surgical Procedures
KW - Female
KW - Humans
KW - Length of Stay
KW - Male
KW - Postoperative Complications/epidemiology
KW - Risk Factors
UR - http://www.scopus.com/inward/record.url?scp=85125156298&partnerID=8YFLogxK
U2 - 10.2340/17453674.2022.2196
DO - 10.2340/17453674.2022.2196
M3 - Journal article
C2 - 35195270
SN - 1745-3674
VL - 93
SP - 341
EP - 347
JO - Acta Orthopaedica
JF - Acta Orthopaedica
ER -