A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Amlie, E; Lerdal, Anners; Høvik, Øystein; Nordsletten, Lars; Dimmen, Sigbjørn

doi:10.1155/2016/7901953

Cited by 17 publications

(21 citation statements)

References 26 publications

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“…It has been questioned whether the fast-track program can increase the risk of PJI and the findings in a small sample from Norway (Amlie et al. 2016 ) raised concern leading to the program being abandoned after a short period. In contrast, a much larger study from Denmark (Glassou et al.…”

Section: Discussionmentioning

confidence: 99%

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No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: An observational before-and-after study of 14,148 total joint replacements 2011–2015

et al. 2018

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Background and purpose — Fast-track care programs in elective total hip and knee replacement (THR/TKR) have been introduced in several countries during the last decade resulting in a significant reduction of hospital stay without any rise in readmissions or early adverse events (AE). We evaluated the risk of readmissions and AE within 30 and 90 days after surgery when a fast-track program was introduced in routine care of joint replacement at 8 Swedish hospitals.Patients and methods — Fast-track care programs were introduced at 8 public hospitals in Västra Götaland region from 2012 to 2014. We obtained data from the Swedish Hip and Knee Arthroplasty Registers for patients operated with THR and TKR in 2011–2015. All readmissions and new contacts with the health care system within 3 months with a possible connection to the surgical intervention were requested from the regional patient register. We compared patients operated before and after the introduction of the fast-track program.Results — Implementation of the fast-track program resulted in a decrease in median hospital length of stay (LOS) from 5 to 3 days in both THR and TKR. The total readmission rate <90 days for THR was 7.2% with fast-track compared with 6.7% in the previous program, and for TKR 8.4% in both groups. Almost half of the readmissions occurred without any AE identified. There was no statistically significant difference concerning readmissions or AE when comparing the programs.Interpretation — Implementation of a fast-track care program in routine care of elective hip and knee replacement is effective in reducing hospital stay without increasing the risk of readmissions or adverse events within 90 days after surgery.

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Section: Discussionmentioning

confidence: 99%

“…One publication has reported a trend to higher infection rate after introducing the fast-track concept in THR (Amlie et al. 2016 ), but most studies are supporting equal or better results compared with conventional care in different outcome measures (Pilot et al. 2006 , Husted et al.…”

mentioning

confidence: 99%

No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: An observational before-and-after study of 14,148 total joint replacements 2011–2015

et al. 2018

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“…An earlier study raised the possibility of an association between an elevated infection-related revision risk and the introduction of a fast-track protocol (Amlie et al. 2016 ). In contrast to previous studies (den Hartog et al.…”

Section: Discussionmentioning

confidence: 99%

Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip replacement

et al. 2017

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Background and purposeFast-track protocols have been successfully implemented in many hospitals as they have been shown to result in shorter length of stay (LOS) without compromising results. We evaluated the effect of fast-track implementation on the use of institutional care and results after total hip replacement (THR).Patients and methods3,193 THRs performed in 4 hospitals between 2009–2010 and 2012–2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified as fast-track (Hospital A) and non-fast-track (Hospitals B, C, and D). We analyzed LOS, length of uninterrupted institutional care (LUIC, including LOS), discharge destination, readmission, revision rate, and mortality in each hospital. We compared these outcomes for THRs performed in Hospital A before and after fast-track implementation and we also compared outcomes, excluding readmission rates, with the corresponding outcomes for the other hospitals.ResultsAfter fast-track implementation, median LOS in Hospital A diminished from 5 to 2 days (p < 0.001) and (median) LUIC from 6 to 3 (p = 0.001) days. No statistically significant changes occurred in discharge destination. However, the reduction in LOS was combined with an increase in the 42-day readmission rate (3.1% to 8.3%) (p < 0.001). A higher proportion of patients were at home 1 week after THR (p < 0.001) in Hospital A after fast-tracking than before.InterpretationThe fast-track protocol reduces LUIC but needs careful implementation to maintain good quality of care throughout the treatment process.

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“…Surgical procedures requiring the use of prosthetic devices are particularly exposed to the risk of infection, and among these, orthopaedics raise particular concerns [16][17][18][19][20]. Many international studies have investigated which variables are associated with the onset of infections in orthopaedic implantation surgery, identifying the most common microorganisms, procedures, prostheses, patients, physical conditions and comorbidities involved, from severe obesity to cancer and chronic HIV infection [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Pirisi¹,

Pennestrì

Viganò

et al. 2020

BMC Infect Dis

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Background: Healthcare-associated infections (HAIs) represent a serious burden to individual safety and healthcare sustainability. Identifying which patients, procedures and settings are most at risk would offer a significant contribution to HAI management and prevention. The purpose of this study is to estimate 1) orthopaedic implantable device-related infection (OIDRI) prevalence in Italian hospitals and 2) the gap between the remuneration paid by the Italian healthcare system and the real costs sustained by Italian hospitals to treat these episodes. Methods: This is a cross-sectional study based on hospital discharge forms registered in 2012 and 2014. To address the first goal of this study, the national database was investigated to identify 1) surgical procedures associated with orthopaedic device implantation and 2) among them, which patient characteristics (age, sex), type of admission, and type of discharge were associated with a primary diagnosis of infection. To address the second goal, 1) each episode of infection was multiplied by the remuneration paid by the Italian healthcare system to the hospitals, based on the diagnosis-related group (DRG) system, and 2) the total days of hospitalization required to treat the same episodes were multiplied by the average daily cost of hospitalization, according to estimates from the Ministry of the Economy and Finance (MEF). Results: In 2014, 1.55% of the total hospitalizations for orthopaedic device implantation procedures were associated with a main diagnosis of infection, with a negligible increase of 0.04% compared with 2012. Hip and knee replacement revisions, male patients and patients older than 65 years were more exposed to infection. A total of 51.63% of patients were planned admissions to the hospital, 68.75% had an ordinary discharge to home, and 0.9% died. The remuneration paid by the healthcare system to the hospitals was € 37,519,084 in 2014, with 3 DRGs covering 70.6% of the total. The cost of the actual days of hospitalization to treat these episodes was 17.5 million more than the remuneration received. Conclusions: The OIDRI prevalence was lower than that described in recent surveys in acute care settings, although the numbers were likely underestimated. The cost of treatment varied significantly depending on the remuneration system adopted.

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A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Cited by 17 publications

References 26 publications

No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: An observational before-and-after study of 14,148 total joint replacements 2011–2015

No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: An observational before-and-after study of 14,148 total joint replacements 2011–2015

Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip replacement

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

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