Fast Track THR: One Hospitalís Experience with a 2-Day Length of Stay Protocol for Total Hip Replacement


Lawrence V. Gulotta, MD

Lawrence V. Gulotta, MD

Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College

Douglas E. Padgett, MD

Douglas E. Padgett, MD

Chief of the Hip Service, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery

Thomas P. Sculco, MD

Thomas P. Sculco, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Surgeon-in-Chief Emeritus, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College

Michael K. Urban, MD, PhD

Michael K. Urban, MD, PhD

Associate Attending Anesthesiologist, Hospital for Special Surgery

Stephen Lyman, PhD
Department of Epidemiology and Biostatistics, Hospital for Special Surgery

Bryan J. Nestor, MD
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor in Orthopaedic Surgery, Weill Cornell Medical College

 

Abstract

Background 
Current trends in total joint replacement have focused on shorter hospital stays.

Purpose 
This study aimed to determine if a pathway for total hip replacement (THR) with the goal of a 2-day discharge (fast track) is safe and effective compared to our traditional pathway (control).

Methods 
One hundred forty-nine patients undergoing unilateral, uncomplicated, THR were enrolled in an accelerated postoperative pathway and 134 were enrolled in the traditional pathway. Patients were followed prospectively and outcomes included hospital length of stay, intra- and postoperative complications, readmissions, reoperations. A statistical model was created to determine factors predictive of a 2-day discharge.

Results 
At 1 year, there were no differences in complications, readmissions, or reoperations. The average length of stay decreased from 4.1 to 2.6 days (p#<#0.0001). In the fast track group, 58% of patients were discharged home within 2 days. Barriers to a 2-day discharge were postoperative pain, nausea, and dizziness. The only preoperative factor that was predictive of a 2-day discharge was hypertension.

Conclusions 
In a select group of patients, a protocol that allows for a 2-day discharge following THR is safe and effective.

This article appears in HSS Journal: Volume 7, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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