Implementation of fast-track surgery program in total hip arthroplasty

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• 作者：Joã ; o Duarte Silva ; ^{joao.duartesilva@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Bernardo Nunes ; Mariana Ferreira ; Manuel Seara ; Antó ; nio Mateus ; Antonio Sousa ; Artur Antunes ; Rui Pinto
• 刊名：Revue de Chirurgie Orthopédique et Traumatologique
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：102
• 期：7_supp_S
• 页码：S89-S90
• 全文大小：60 K

文摘

The surgical trauma in the total hip arthroplasty (THA) causes pain, catabolism, altered basal metabolism and increased thromboembolic risk. This can result in prolonged hospitalization and rehabilitation. The optimization of individual perioperative care with the fast-track method (Rapid Recovery Biomet y) reduces the length of hospitalization, morbidity and saves resources without apparent increase in complications. The aim of this study was to evaluate the Introduction of fast-track method in the primary THA in our hospital.

Methods

Cohort study including the first 48 patients intervened in 2012 under the fast-track program (RR) and 68 control patients (GC) undergoing THA in 2011 that would meet the criteria for including the Rapid Recovery program. We evaluated: age, gender, type of arthroplasty, co-morbidities, days of hospitalization, early postoperative complications, wound complications, dislocations and early re-hospitalization for any reason.

Results

In the control group- mean age 64.10 ± 12.7 years, 64.7% female, 69.11% right hip, 69.1% THA cemented, 1.4% hybrid THA and 29.5% THA cementless. In the RR group, mean age 67.44 ± 8.29 years, 62.08% female, 70.08% right hip, 41.67% THA cemented, 56.25% THA cementless and 2.08% THA hybrid. Admission times total (GC 6.72 ± 1.6 days; RR 5.69 ± 1.6 days), preoperative (GC 1.3 ± 0.754 days; RR 0.97 ± 0.25 days) postoperative (GC 4.34 ± 1.6 days; RR 3.70 ± 1.58 days). Complications hospitalization (GC 5.88%; RR 6.25%), skin complications (GC 4.4%; RR 2.01%), dislocations and early re-hospitalization (GC 1.4%; RR 2.01%). The RR group recorded 3 complications during hospitalization, 4 skin complications and 1 THA dislocation. The GC noted 5 complications in hospital, 5 skin complications and 1 THA dislocation. No statistically significant difference between both groups in relation to age (ANOVA p = 0.115), gender (p = 0.159), co-morbidities (p = 0.212), types of arthroplasties (p = 0.0585), complications during hospitalization (Student t p = 0.068), skin complications (Student t p = 0.251) and dislocations or early re-hospitalization (Student t p = 0.278). We note a significant reduction of the preoperative time (ANOVA p < 0.001), total hospitalization (ANOVA p < 0.001) and postoperative time (ANOVA p = 0.037) in the RR group.

Discussion/conclusion

Multimodal assessment and proper preparation of the patient in the period before hospitalization allowed a reduction in the preoperative period. The introduction of the Rapid Recovery y program in THA in our institution allowed a standardization of access, rehabilitation and discharge criteria, significantly reducing the time hospitalization without showing an increased number of complications.