Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

Louise O.H. Daugberg; Henrik Kehlet; Pelle B. Petersen; Thomas Jakobsen; Christoffer C. Jørgensen; The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group; Frank Madsen; Torben Bæk Hansen; Kirill Gromov; Lars Tambour Hansen; Claus Varnum; Mikkel Rathsach Andersen; Niels Harry Krarup; Søren Overgaard

doi:10.1007/s00402-023-04887-x

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

Louise O.H. Daugberg^*, Henrik Kehlet, Pelle B. Petersen, Thomas Jakobsen, Christoffer C. Jørgensen, The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group, Frank Madsen (Member of study group), Torben Bæk Hansen (Member of study group), Kirill Gromov (Member of study group), Lars Tambour Hansen (Member of study group), Claus Varnum (Member of study group), Mikkel Rathsach Andersen (Member of study group), Niels Harry Krarup (Member of study group), Søren Overgaard (Member of study group)

^*Corresponding author for this work

Abstract

INTRODUCTION: Gastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0-1%, and 0.1-1.7%, respectively. The use of enhanced recovery or "fast-track" protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up.

MATERIALS AND METHODS: This is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications.

RESULTS: The cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%-0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding.

CONCLUSIONS: The risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).

Original language	English
Journal	Archives of Orthopaedic and Trauma Surgery
Volume	143
Issue number	10
Pages (from-to)	6033-6038
Number of pages	6
ISSN	0003-9330
DOIs	https://doi.org/10.1007/s00402-023-04887-x
Publication status	Published - Oct 2023

Keywords

C. difficile
Fast-track
GI-bleed
GI-complications
POI
THA
TKA
Length of Stay
Arthroplasty, Replacement, Knee/adverse effects
Prospective Studies
Patient Readmission
Humans
Risk Factors
Male
Arthroplasty, Replacement, Hip/adverse effects
Gastrointestinal Diseases/complications
Postoperative Complications/epidemiology
Clostridioides difficile
Female

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Daugberg, L. O. H., Kehlet, H., Petersen, P. B., Jakobsen, T., Jørgensen, C. C., The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group, Madsen, F., Hansen, T. B., Gromov, K., Hansen, L. T., Varnum, C., Andersen, M. R., Krarup, N. H., & Overgaard, S. (2023). Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort. Archives of Orthopaedic and Trauma Surgery, 143(10), 6033-6038. https://doi.org/10.1007/s00402-023-04887-x

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort. / Daugberg, Louise O.H.; Kehlet, Henrik; Petersen, Pelle B. et al.
In: Archives of Orthopaedic and Trauma Surgery, Vol. 143, No. 10, 10.2023, p. 6033-6038.

Research output: Contribution to journal › Journal article › Research › peer-review

Daugberg, LOH, Kehlet, H, Petersen, PB, Jakobsen, T, Jørgensen, CC, The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group, Madsen, F, Hansen, TB, Gromov, K, Hansen, LT, Varnum, C, Andersen, MR, Krarup, NH & Overgaard, S 2023, 'Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort', Archives of Orthopaedic and Trauma Surgery, vol. 143, no. 10, pp. 6033-6038. https://doi.org/10.1007/s00402-023-04887-x

Daugberg LOH, Kehlet H, Petersen PB, Jakobsen T, Jørgensen CC, The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group et al. Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort. Archives of Orthopaedic and Trauma Surgery. 2023 Oct;143(10):6033-6038. doi: 10.1007/s00402-023-04887-x

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title = "Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort",

abstract = "INTRODUCTION: Gastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0-1%, and 0.1-1.7%, respectively. The use of enhanced recovery or {"}fast-track{"} protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up.MATERIALS AND METHODS: This is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications.RESULTS: The cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%-0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding.CONCLUSIONS: The risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).",

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author = "Daugberg, {Louise O.H.} and Henrik Kehlet and Petersen, {Pelle B.} and Thomas Jakobsen and J{\o}rgensen, {Christoffer C.} and {The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group} and Frank Madsen and Hansen, {Torben B{\ae}k} and Kirill Gromov and Hansen, {Lars Tambour} and Claus Varnum and Andersen, {Mikkel Rathsach} and Krarup, {Niels Harry} and S{\o}ren Overgaard",

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year = "2023",

month = oct,

doi = "10.1007/s00402-023-04887-x",

language = "English",

volume = "143",

pages = "6033--6038",

journal = "Archives of Orthopaedic and Trauma Surgery",

issn = "0003-9330",

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TY - JOUR

T1 - Gastrointestinal complications after fast-track total hip and knee replacement

T2 - an observational study in a consecutive 36,932 patient cohort

AU - Daugberg, Louise O.H.

AU - Kehlet, Henrik

AU - Petersen, Pelle B.

AU - Jakobsen, Thomas

AU - Jørgensen, Christoffer C.

AU - The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement collaborative Group

A2 - Madsen, Frank

A2 - Hansen, Torben Bæk

A2 - Gromov, Kirill

A2 - Hansen, Lars Tambour

A2 - Varnum, Claus

A2 - Andersen, Mikkel Rathsach

A2 - Krarup, Niels Harry

A2 - Overgaard, Søren

PY - 2023/10

Y1 - 2023/10

N2 - INTRODUCTION: Gastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0-1%, and 0.1-1.7%, respectively. The use of enhanced recovery or "fast-track" protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up.MATERIALS AND METHODS: This is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications.RESULTS: The cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%-0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding.CONCLUSIONS: The risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).

AB - INTRODUCTION: Gastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0-1%, and 0.1-1.7%, respectively. The use of enhanced recovery or "fast-track" protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up.MATERIALS AND METHODS: This is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications.RESULTS: The cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%-0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding.CONCLUSIONS: The risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).

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KW - TKA

KW - Length of Stay

KW - Arthroplasty, Replacement, Knee/adverse effects

KW - Prospective Studies

KW - Patient Readmission

KW - Humans

KW - Risk Factors

KW - Male

KW - Arthroplasty, Replacement, Hip/adverse effects

KW - Gastrointestinal Diseases/complications

KW - Postoperative Complications/epidemiology

KW - Clostridioides difficile

KW - Female

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U2 - 10.1007/s00402-023-04887-x

DO - 10.1007/s00402-023-04887-x

M3 - Journal article

C2 - 37186076

SN - 0003-9330

VL - 143

SP - 6033

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JO - Archives of Orthopaedic and Trauma Surgery

JF - Archives of Orthopaedic and Trauma Surgery

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ER -

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

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Keywords

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