July 1, 2011
Earlier Exit From Hospital After Hip Operation
New study suggests 'Fast Track' total hip replacement is both safe and effective
Discharged from the hospital within two days of a total hip replacement operation? It's possible, thanks to the new 'Fast Track' protocol that underwent testing in the U.S., in response to both patient requests for shorter hospital stays and economic realities of providing medical care. According to Dr. Lawrence Gulotta and colleagues, from Hospital for Special Surgery in New York, a carefully screened group of patients undergoing total hip replacement can be discharged from the hospital two days after surgery, without any increase in complications or adverse effects compared with the more traditional protocol. Their work is published online in Springer's HSS Journal.The Fast Track protocol encourages patients to get up and move around earlier and more frequently. Hospital-based epidural pain relief is stopped earlier and patients are given aspirin to prevent blood clots. In addition, arrangements are made for a physical therapist to work with the patient at home after discharge.
The authors compared length of hospital stay, safety and peri-operative complications between two groups of patients over a two-year period. A total of 134 patients experienced the standard post-operative route where the discharge goal was four days at that time, and 149 enrolled in the Fast Track protocol where the goal was to discharge patients within two days of surgery.
The average length of stay in the Fast Track group was just over 2.5 days compared with patients in the traditional group who, on average, were discharged after four days or more. Of those undergoing the Fast Track approach, 58 percent were successfully discharged within two days of surgery, and 73 percent within three days.
Although five patients were readmitted from the Fast Track group, compared with only one from the traditional group, the authors found no differences in the rates of overall complications between the two groups. In addition, fewer patients felt dizzy after the operation with the Fast Track protocol than the traditional version (19 percent versus 42 percent).
The authors also looked at factors that might predict successful two-day discharges. They found that people with normal blood pressure were more likely to be discharged within two days than those with hypertension, as were those who experienced no post-operative nausea or dizziness. Indeed, postoperative pain, nausea and dizziness interfered with physical therapy and, as a result, were the main reasons for an unsuccessful two-day discharge.
Gulotta and colleagues conclude: "Since there were no differences in complication, readmission, and reoperation rates for the Fast Track group compared with the Control group in this study, we feel this proves that a two-day discharge following uncomplicated total hip replacement in a select group of relatively healthy patients is safe. The program is effective at reducing hospital length of stay. What we cannot assess at this stage is whether we achieved any actual cost savings."
Bryan Nestor, M.D., orthopedic surgeon in the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery, was principal investigator of the study. Other HSS authors involved in the study are Douglas Padgett, M.D., Thomas Sculco, M.D., Michael Urban, M.D., PhD, and Stephen Lyman, Ph.D.
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