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

Berg, Urban; Bülow, Erik; Sundberg, Martin; Rolfson, Ola

doi:10.1080/17453674.2018.1492507

Cited by 55 publications

(66 citation statements)

References 32 publications

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“…The median LOS was 3 days, which is similar to what has been reported in the recent literature [1,3,5,6,10]. A few studies report a median LOS of 2 days [7,15].…”

Section: Length Of Staysupporting

confidence: 86%

Reasons and Risk Factors for Delayed Discharge After Total Knee Arthroplasty Using an Opioid-Sparing Discharge Protocol

Saku

Mäkinen

Madanat

2019

The Journal of Arthroplasty

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Background: In this study, we aimed to assess the length of hospital stay after total knee arthroplasty in a European healthcare setting. We also aimed to investigate risk factors and reasons for delayed discharge when using an opioid-sparing fast-track protocol. Methods: From our institutional database, we retrospectively identified all primary elective unilateral total knee arthroplasties performed during January to December 2015. Both patient-related and surgeryrelated variables were collected from our databases. Risk factors were analyzed using multivariable logistic regression analysis. Results: The median length of stay (LOS) was 3 days. Independent risk factors for delayed discharge were higher age, higher American Society of Anesthesiologists score, general anesthesia, surgery performed toward the end of the week, longer duration of surgery, longer stay in the post-anesthesia care unit, and shorter preoperative walking distance. The main reasons for delayed discharge were delayed functional recovery and pain. Conclusion: This study identified several independent risk factors for an LOS longer than 3 days. These risk factors add to the current knowledge on which patients have an increased risk of prolonged LOS, and which patients should be targeted when striving to further reduce the LOS.

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“…The median LOS was 3 days, which is similar to what has been reported in the recent literature [1,3,5,6,10]. A few studies report a median LOS of 2 days [7,15].…”

Section: Length Of Staysupporting

confidence: 86%

Reasons and Risk Factors for Delayed Discharge After Total Knee Arthroplasty Using an Opioid-Sparing Discharge Protocol

Saku

Mäkinen

Madanat

2019

The Journal of Arthroplasty

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“…Moreover, more than half of Italian providers are represented by low-volume healthcare institutions, which are generally disadvantaged in implementing effective accelerated pathways [ 19 , 20 ]. This is why most of the comparisons between conventional treatment and accelerated pathways are performed within the same healthcare supplier or through before-after observational studies [ 21 – 23 ].…”

Section: Resultsmentioning

confidence: 99%

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Vanni

Foglia

Pennestrì

et al. 2020

BMC Health Serv Res

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Background: The number of patients undergoing joint arthroplasty is increasing worldwide. An Enhanced Recovery After Surgery (ERAS) pathway for hip and knee arthroplasty was introduced in an Italian high-volume research hospital in March 2018. Methods: The aim of this mixed methods observational study is to perform a health technology assessment (HTA) of the ERAS pathway, considering 938 procedures performed after its implementation, by means of a hospitalbased approach derived from the EUnetHTA (European Network for Health Technology Assessment) Core Model. The assessment process is based on dimensions of general relevance, safety, efficacy, effectiveness, economic and financial impact, equity, legal aspects, social and ethical impact, and organizational impact. A narrative review of the literature helped to identify general relevance, safety and efficacy factors, and a set of relevant sub-dimensions submitted to the evaluation of the professionals who use the technology through a 7-item Likert Scale. The economic and financial impact of the ERAS pathway on the hospital budget was supported by quantitative data collected from internal or national registries, employing economic modelling strategies to identify the amount of resources required to implement it. Results: The relevance of technology under assessment is recognized worldwide. A number of studies show accelerated pathways to dominate conventional approaches on pain reduction, functional recovery, prevention of complications, improvements in tolerability and quality of life, including fragile or vulnerable patients. Qualitative surveys on clinical and functional outcomes confirm most of these benefits. The ERAS pathway is associated with a reduced length of stay in comparison with the Italian hospitalization average for the same procedures, despite the poor spread of the pathway within the country may generate postcode inequalities. The economic analyses show how the resources invested in training activities are largely depreciated by benefits once the technology is permanently introduced, which may generate hospital cost savings of up to 2054,123.44 € per year. Conclusions: Galeazzi Hospital's ERAS pathway for hip and knee arthroplasty results preferable to traditional approaches following most of the HTA dimensions, and offers room for further improvement. The more comparable practices are shared, the before this potential improvement can be identified and addressed.

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“…Marital status was not addressed in our study, but it could be that elderly female patients might more often be widowed than male patients, due to the fact that the life expectancy of males is about six years shorter than for females [26] and thus not have spouses at home to take care of them after discharge from the hospital. LOS > 3 days was also associated with older age and higher ASA scores (3)(4). In addition, patients Table 2 Differences of means, 95% CI and p-values in the LOS, PACU time and the length of total surgical process between the intervention group and the control group, gender within the groups and the surgical procedures total hip arthroplasty (THA) and total knee arthroplasty (TKA).…”

Section: Discussionmentioning

confidence: 99%

“…Both procedures usually result in improvements to mobilization and overall quality of life for the patients [ 1 , 2 ]. Fast-track protocols and different kinds of early recovery programs have been implemented that have shortened LOS following THA and TKA procedures [ 3 – 6 ]. In some institutions, THA and TKA are already being performed as day surgery procedures in select cases with promising results.…”

Section: Introductionmentioning

confidence: 99%

The effect of a new perioperative practice model on length of hospital stay and on the surgical care process in patients undergoing hip and knee arthroplasty under spinal anesthesia: a randomized clinical trial

et al. 2020

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Background: The shortened length of hospital stays (LOS) requires efficient and patient-participatory perioperative nursing approaches to enable early and safe discharge from hospitals for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The primary aim of this study was to explore the effect comparative to standard perioperative care of a new perioperative practice model (NPPM) on the LOS and the time points of the surgical care process in patients undergoing THA and TKA under spinal anesthesia. The secondary aim was to find out if any subgroups with different response could be found. Methods: Patients scheduled for elective, primary THA and TKA were assessed for eligibility. A two-group parallel randomized clinical trial was conducted with an intervention group (n = 230) and control group (n = 220), totaling 450 patients. The patients in the intervention group were each designated with one named anesthesia nurse, who took care of the patient during the entire perioperative process and visited the patient postoperatively. The patients in the control group received standard perioperative care from different nurses during their perioperative processes and without postoperative visits. The surgical care process time points for each study patient were gathered from the operating room management software and hospital information system until hospital discharge. Results: We did not find any statistically significant differences between the intervention and control groups regarding to LOS. Only slight differences in the time points of the surgical care process could be detected. The subgroup examination revealed that higher age, type of arthroplasty and ASA score 3-4 all separately caused prolonged LOS. Conclusion: We did not find the new perioperative practice model to shorten either length of hospital stays or the surgical care process in patients undergoing THA and TKA. Further studies at the subgroup level (gender, old age, and ASA score 3 and 4) are needed to recognize the patients who might benefit most from the NPPM.

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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

Cited by 55 publications

References 32 publications

Reasons and Risk Factors for Delayed Discharge After Total Knee Arthroplasty Using an Opioid-Sparing Discharge Protocol

Reasons and Risk Factors for Delayed Discharge After Total Knee Arthroplasty Using an Opioid-Sparing Discharge Protocol

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

The effect of a new perioperative practice model on length of hospital stay and on the surgical care process in patients undergoing hip and knee arthroplasty under spinal anesthesia: a randomized clinical trial

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