Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017

Pelle Baggesgaard Petersen,Per Kjærsgaard-Andersen,Niels Harry Krarup,Jens Bagger,Christoffer Calov Jørgensen,Frank Madsen,Mogens Laursen, ,Lars Tambour Hansen,Henrik Kehlet,Torben Bæk Hansen,Kirill Gromov,Soren Solgaard

doi:10.1038/s41598-020-77127-6

Pelle Baggesgaard Petersen, Per Kjærsgaard-Andersen + Show 11 more

Open Access

https://doi.org/10.1038/s41598-020-77127-6

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Abstract

“Fast-track” protocols has improved surgical care with a reduction in length of hospital stay (LOS) in total hip (THA) and knee arthroplasty (TKA). However, the effects of continuous refinement of perioperative care lack detailed assessment. We studied time-related changes in LOS and morbidity after THA and TKA within a collaboration with continuous scientific refinement of perioperative care. Prospective multicentre consecutive cohort study between 2010 and 2017 from nine high-volume orthopaedic centres with established fast-track THA and TKA protocols. Prospective collection of comorbidities and complete 90-day follow-up from the Danish National Patient Registry and medical records. Of 36,935 procedures median age was 69 [62 to 75] years and 58% women. LOS declined from three [two to three] days in 2010 to one [one to two] day in 2017. LOS > 4 days due to “medical” or “surgical” complications, and “with no recorded morbidity” declined from 4.4 to 2.7%, 1.5 to 0.6%, and 3.8 to 1.3%, respectively. 90-days readmission rate declined from 8.6 to 7.7%. Our multicentre study in a socialized healthcare setting was associated with a continuous reduction in LOS and morbidity after THA and TKA.

Highlights

length of stay (LOS) decreased throughout the study period from median three [2 to 3] days (mean 3.0 (± 2.4) days) in 2010 to one [1 to 2] day (mean 1.9 (± 1.6) days) in 2017 (Mann–Kendall p = 0.049) (Fig. 2a)
The proportion with LOS > four days decreased from 9.7% in 2010 to 4.6% in 2017 (Mann–Kendall p = 0.004) (Fig. 2b)
In-hospital “medical” complications leading to LOS > 4 days did not decline monotonically from 2010 to 2017 (Mann–Kendall p = 0.108), but with a constant decrease starting in 2014 (4.4% in 2014 to 2.7% in 2017)

Summary

Objectives

The primary objective was to investigate changes in LOS and in-hospital morbidity resulting in LOS > 4 days, and 90-day readmissions over time. Secondary outcomes were analyses of specific in-hospital complications leading to LOS > 4 days and/or readmission ≤ 90 days and a division into composite outcomes of “surgical” and “medical” complications. Categorical data are reported as actual number (%) and compared using chi-square or Fisher’s exact test as appropriate. “medical” and “surgical” morbidity rates we included only the first readmission. When reporting specific types of morbidity all readmissions were included. Initial data analysis was done using SPSS v.25 (IBM Corp, Armonk, NY, USA) while Mann–Kendall Analysis and plots were made in R (R Core Team, 2019) using the “Kendall” (Mcleod, 2011) and “ggplot2” (Wickham, 2016) packages

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Conclusion