THA with a minimally invasive technique, multi-modal anesthesia, and home rehabilitation: factors associated with early discharge?
Multimodal anesthetic and pain regimens with minimally invasive surgical approaches and rapid rehabilitation protocols are thought to decrease length of stay after hip replacement. We asked whether a program including these three elements could achieve 23-hour discharge in a group of 665 patients and whether the length of hospital stay was influenced by patient age, gender, body mass index, change in hemoglobin or estimated blood loss, duration of surgery (< or = 90 or > 90 minutes), or American Society of Anesthesiologists physical status classification. Of the 665 patients, 259 (38.9%) were discharged home with indwelling peripheral nerve catheters. Hospital discharge in less than 24 hours was achieved in 295 (44.4%) of the 665 patients. After discharge, 73.5% of patients required no home or outpatient nursing care or physical therapy. Eighteen (2.7%) dislocations, eight (1.2%) femoral fractures requiring surgery, and thirteen (2.0%) revision procedures occurred within 90 days. Female gender, increasing age, increasing estimated blood loss, and American Association of Anesthesiologists classification 3 or 4 increased length of stay. Additional study is needed to confirm these factors and develop prospective prediction rules to allow for an outpatient approach to joint arthroplasty.


METHODS
Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Mears
Dana Christopher
DC
University of Pittsburgh Medical Center, PA, USA.
Mears
Simon C
SC
Chelly
Jacques E
JE
Dai
Feng
F
Vulakovich
Katie L
KL
D000758:Anesthesia / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D002408:Catheters, Indwelling; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D016018:Least-Squares Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010351:Patient Discharge; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors