Abstract
BackgroundTotal hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints.MethodsNinety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS, and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Student t test, and Poisson regression approach.ResultsThe FTS and control groups were similar in age and sex distribution (p > 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p < 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001).ConclusionUse of FTS was associated with decreased LOS, compared with conventional THA.Trial registrationhttps://www.researchsquare.com/article/rs-369025/v1.
Highlights
Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis
The fast-track surgery (FTS) and control groups were similar in age distribution (p > 0.05), and most patients were older than 50 years
No patient in the FTS group stayed in hospital for more than 6 days, whereas for 56.8% of the controls, the time that elapsed until hospital discharge was seven or more days (p < 0.001) (Table 3)
Summary
Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is generally considered to be a traumatic surgical procedure and it has been associated with intraoperative blood loss, intense postoperative pain, requirement for intensive care unit (ICU) use, and prolonged immobilization. This complex scenario may delay patients’ functional rehabilitation and prolong their hospital length of stay (LOS) [3]. Novel evidence-based protocols targeting surgical patients’ care emerged in the early 1990s, with the aim of accelerating postoperative recovery These were put forward by Professor Henrik Kehlet for use within colorectal surgery. This has the potential to lead to lower mortality and morbidity, along with optimizing patient satisfaction [5,6,7,8,9,10,11,12]
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