Fast-Track Programs in Total Hip and Knee Replacement at Swedish Hospitals-Influence on 2-Year Risk of Revision and Mortality.

Martin Sundberg,Emma Nauclér,Urban Berg,Ola Rolfson,Anna Nilsdotter,Annette W-Dahl

doi:10.3390/jcm10081680

Abstract

Purpose: We aimed to study the influence of fast-track care programs in total hip and total knee replacements (THR and TKR) at Swedish hospitals on the risk of revision and mortality within 2 years after the operation. Methods: Data were collected from the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR), including 67,913 THR and 59,268 TKR operations from 2011 to 2015 on patients with osteoarthritis. Operations from 2011 to 2015 Revision and mortality in the fast-track group were compared with non-fast-track using Kaplan–Meier survival analysis and Cox regression analysis with adjustments. Results: The hazard ratio (HR) for revision within 2 years after THR with fast-track was 1.19 (CI: 1.03–1.39), indicating increased risk, whereas no increased risk was found in TKR (HR 0.91; CI: 0.79–1.06). The risk of death within 2 years was estimated with a HR of 0.85 (CI: 0.74–0.97) for TKR and 0.96 (CI: 0.85–1.09) for THR in fast-track hospitals compared to non-fast-track. Conclusions: Fast-track programs at Swedish hospitals were associated with an increased risk of revision in THR but not in TKR, while we found the mortality to be lower (TKR) or similar (THR) as compared to non-fast track.

Highlights

The primary goal of fast-track care programs is to enhance and accelerate recovery after surgery whilst maintaining patient safety [1]
Some publications have reported an increased risk of revision associated with the implementation of a fast-track program in total hip and knee replacement (THR/TKR) [2,3], but it has been assumed that other reasons than the care program may explain the higher revision rate
It has been concluded that THR is associated with an increased risk of death within 30 days in patients without co-morbidity and age under 60 years due to risks related to surgical intervention, but the long-term mortality is lower in patients after THR compared to a matched population [6]

Summary

Introduction

The primary goal of fast-track care programs is to enhance and accelerate recovery after surgery whilst maintaining patient safety [1]. Some publications have reported an increased risk of revision associated with the implementation of a fast-track program in total hip and knee replacement (THR/TKR) [2,3], but it has been assumed that other reasons than the care program may explain the higher revision rate. Other studies have not confirmed an increased risk of revision associated to fast-track in THR and TKR [4,5]. The influence of fast-track programs on mortality has been an issue. According to studies from United Kingdom (UK), the mortality rate has been lower within 90 days [7] and 2 years [8] after introduction of fast-track

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