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Hvidovre Hospital - en del af Københavns Universitetshospital
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Days alive and out of hospital after fast-track total hip and knee arthroplasty: an observational cohort study in 16 137 patients

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

DOI

  • Christoffer C Jørgensen
  • Pelle B Petersen
  • Henrik Kehlet
  • Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group (Henrik Husted, Søren Solgaard members)
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Background: Days alive and out of hospital (DAH) has been proposed as a pragmatic outcome measure of surgical quality. However, there is a lack of procedure specific data or data within an optimised fast-track protocol. Furthermore, information about influence of follow-up duration and types of complications on DAH is limited. Methods: Observational multicentre cohort study of patients undergoing fast-track total hip (THA) and knee arthroplasty (TKA). Prospective information on comorbidity and complete 90 days follow-up was undertaken through the Danish National Patient Register and chart review. Results: For 16 137 procedures, of which 18.6% were high-risk (≥2 preoperative risk factors), the median length of stay was 2 days (inter-quartile range [IQR], 2–3), and 30- and 90-day readmission rates were 5.7% and 8.1%, respectively. Median DAH 30 and DAH 90 days were 27 (26–28) and 87 (85–88) vs 28 (27–28) and 88 (87–89) (P<0.001) in high-vs low-risk patients, respectively. The fraction with DAH ≤25 at 30 days and DAH ≤85 at 90 days was increased in high-vs low-risk patients: 23.3% vs 6.8% (odds ratio [OR]=4.16; 95% confidence interval [CI], 3.73–4.65) and 26.0% vs 8.6% (OR=3.75; 95% CI, 3.38–4.16). There were relatively fewer ‘surgical’ complications in high- vs low-risk patients with DAH 30 ≤25 (14.6% vs 25.8%) (OR=0.49; 95% CI, 0.37–0.65) and DAH 90 ≤85 (16.9% vs 31.89%) (OR=0.43; 95% CI, 0.34–0.56). About 2% of patients had readmissions, but DAH was >25 and >85 at 30 and 90 days after operation, respectively. Conclusion: Median DAH in fast-track THA/TKA patients is 28 at 30 days and 88 at 90 days after surgery. DAH in high-risk patients was only slightly reduced compared with low-risk patients, but they have relatively more ‘medical’ complications.

OriginalsprogEngelsk
TidsskriftBritish Journal of Anaesthesia
Vol/bind123
Udgave nummer5
Sider (fra-til)671-678
Antal sider8
ISSN0007-0912
DOI
StatusUdgivet - nov. 2019

Bibliografisk note

Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

ID: 57916181