Abstract
Introduction
Fast-track surgery is the combination of optimized clinical and organizational factors aiming at reducing convalescence and perioperative morbidity including the functional recovery resulting in reduced hospitalization. As the previous nationwide studies have demonstrated substantial variations in length of stay (LOS) following standardized operations such as total hip and knee arthroplasty (THA and TKA), this nationwide study was undertaken to evaluate the implementation process of fast-track THA and TKA in Denmark.
Materials and methods
All hospitals in Denmark report to the National Patient Registry, linking the type of surgery and LOS with a unique individual social security number. This study is based on primary THA and TKA from a 5.5 million population from 2000 to the end of 2009.
Results
The number of performed primary unilateral THA and TKA has increased from around 7,200 in 2000 to 13,800 in 2009 with a concomitant reduction in LOS from median 10–11 days in 2000 to 4 days in 2009.
Conclusion
Fast-track surgery has been successfully implemented in the orthopedic departments in Denmark through a multi-disciplinary educational and multi-institutional effort. These implementation principles may be transferred to other countries and other specialties.
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References
Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617
Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198
Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793
Husted H, Otte KS, Kristensen BB, Ørsnes T, Kehlet H (2010) Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg 130:1185–1191
Husted H, Otte KS, Kristensen BB, Ørsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605
Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130:263–268
Husted H, Hansen HC, Holm G (2006) Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction. Ugeskr Laeger 168:2148–2151
NHS http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=207
Bundesauswertung 2009 http://www.bqs-outcome.de
Jimenez-Garcıa R, Villanueva-Martınez M, Fernandez-de-Las-Penas C, Hernandez-Barrera V, Rıos-Luna A, Garrido PC, de Andres AL, Jimenez-Trujillo I, Montero JS, Gil-de-Miguel A (2011) Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality. BMC Musculoskelet Disord 12:43
Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Length of stay in total hip and knee arthroplasty in Denmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark. Ugeskr Laeger 168:2139–2143
Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences. Ugeskr Laeger 168:2144–2148
Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173
Andersen SH, Husted H, Kehlet H (2009) Economic consequences of accelerated care pathways in total knee-arthroplasty. Ugeskr Laeger 171:3276–3280
Rud K, Jakobsen DH, Egerod I, Kehlet H (2008) Surgical care guidelines. Ugeskr Laeger 170:1559–1563
Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H (2011) Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg (Br) 93:351–356
Husted H, Otte KS, Kristensen BB, Kehlet H (2011) Fast-track revision knee arthroplasty : a feasibility study. Acta Orthop 82(4):438–440
Khan F, Ng L, Gonzalez S, Hale T, Turner-Stokes L (2008) Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 16(2):CD004957
Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation - is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54
Husted H, Solgaard S, Hansen TB, Søballe K, Kehlet H (2010) Care principles at four fast-track arthroplasty departments in Denmark. Dan Med Bull 57:A4166
Kehlet H, Andersen LØ (2011) Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice? Acta Anaesthesiol Scand 55(7):778–784
Kehlet H, Søballe K (2010) Fast-track hip and knee replacement - what are the issues? Acta Orthop 81:271–272
Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H (2009) Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 64:508–513
Krenk L, Rasmussen LS, Kehlet H (2010) New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 54:951–956
Jans O, Kehlet H, Hussain Z, Johansson PI (2011) Transfusion practice in hip arthroplasty : a nationwide study. Vox Sang 100(4):374–380. doi: 10.1111/j.1423-0410.2010.01428.x
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Husted, H., Jensen, C.M., Solgaard, S. et al. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Trauma Surg 132, 101–104 (2012). https://doi.org/10.1007/s00402-011-1396-0
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DOI: https://doi.org/10.1007/s00402-011-1396-0