Feasibility and Safety of 2-Day Discharge After Fast-Track Total Hip Arthroplasty: A Chinese Experience

Abstract Background A fast-track program (FT) can shorten hospital stay after total hip arthroplasty. The aim of this prospective randomized study was to investigate the feasibility and safety of 2-day discharge after fast-track total hip arthroplasty in a Chinese population. Methods A total of 258...

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Bibliographic Details
Published in:The Journal of arthroplasty 2016-08, Vol.31 (8), p.1686-1692.e1
Main Authors: Yang, Guojing, MD, Chen, Wanchen, MD, Chen, Wenliang, MD, Tang, Xiaojun, MD, Huang, Yijiang, MD, Zhang, Lei, MD
Format: Article
Language:English
Subjects:
Aged
Arthroplasty, Replacement, Hip
Clinical Protocols
complication
early discharge
fast-track surgery
Feasibility Studies
Female
hip arthroplasty
hospital stay
Hospitalization
Humans
Length of Stay
Male
Middle Aged
Orthopedics
outcome
Patient Selection
Perioperative Care - methods
Perioperative Care - standards
Prospective Studies
Treatment Outcome
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Summary:Abstract Background A fast-track program (FT) can shorten hospital stay after total hip arthroplasty. The aim of this prospective randomized study was to investigate the feasibility and safety of 2-day discharge after fast-track total hip arthroplasty in a Chinese population. Methods A total of 258 selected patients who underwent unilateral primary total hip arthroplasty were enrolled into the final cohort and were randomized into the FT ( n  = 126) and standard program group ( n  = 132). In the FT group, the patients received a multidisciplinary FT, whereas the patients in the standard program group only followed a standard care program. After setting restricted discharge criteria, we undertook follow-up evaluations to investigate the length of hospital stay, clinical performance, 30-day and 90-day complications, and 90-day admissions in both groups. A multivariate regression model was used to assess independent predictors of delayed discharge (>2 days). Results The mean length of stay was reduced from 5.8 to 2.1 days after implementation of our FT ( P < .001). Most patients in the FT group (82.5%) were discharged within 2 days postoperatively. However, the complications and readmissions appeared no difference between the two groups. The multivariate regression analysis identified age ( P  = .041), operative time ( P < .001), intraoperative blood loss ( P  = .026), and total blood loss ( P < .001) as the predictive factors for delayed discharge. Conclusion A 2-day discharge protocol after fast-track total hip arthroplasty can be safe and feasible in selected patients, without increasing the risk of complications and readmissions. Further efforts are needed to shorten operative time and reduce perioperative blood loss and eventually to shorten hospital stay.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2016.02.011