Temporal trends in length of stay and readmissions after fast-track hip and knee arthroplasty

INTRODUCTION: Implementation of fast-track protocols in total hip and knee arthroplasty (THA/TKA) has dramatically changed the perioperative care, leading to a subsequent reduction in post-operative length of stay (LOS) and mor-bidity. Previous investigations in Denmark have shown a reduction in LOS from about ten days in 2000 to four days in 2009. We aimed to describe temporal changes in LOS and readmissions within the context of a continuous multicentre collaboration focusing on enhancing recovery and reducing morbidity after fast-track THA and TKA.

METHODS: We used an observational cohort design from nine Danish orthopaedic centres. All procedures were performed from January 2010 to August 2017. Data on LOS and 90-day readmissions were obtained from The Danish National Patient Registry. Cause of readmission and possible association with surgery were investigated using discharge summaries or health records.

RESULTS: We included 36,608 procedures with a median age of 69 (range: 62-75) years of whom 58% were women. LOS decreased from a median of three (range: 2-3) days in 2010 to one (range: 1-2) days in 2017. The proportion of patients with LOS > 4 days decreased from 9.6% to 4.4%. Still, 90-day readmissions remained stable throughout the period at ≈ 8%.

CONCLUSIONS: A reduction in both LOS and proportion of patients with prolonged LOS without an increase in readmission is possible within a multicentre collaboration aiming at enhancing recovery and reducing morbidity.

FUNDING: The study was supported by an unconditional PhD grant from Lundbeckfonden to PBP (R230-2017-166).

TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT01515670).