Readmissions after fast-track hip and knee arthroplasty.
BACKGROUND
With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA).


METHODS
1,731 consecutive, unselected patients were operated with primary THA or TKA in a well-described standardized fast-track setup from 2004 to 2008. All readmissions and deaths within 90 days were analyzed using the national health register.


RESULTS
Mean LOS decreased from 6.3 to 3.1 days. Within 90 days, 15.6% of patients following TKA were readmitted as opposed to 10.9% after THA (p = 0.005). Three deaths (0.17%) were associated with clotting episodes. Suspicion of DVT (not found) and suspicion of infection made up half of the readmissions. Readmissions in general and for thromboembolic events, dislocations and manipulations in specific did not increase with decreasing LOS. There was no difference between readmission rates per year for either TKA or THA but there was a significantly reduced risk of dislocation found with decreasing LOS comparing each year from 2005 to 2007 with the index year of 2004 (with the longest LOS and the highest incidence of dislocation).


CONCLUSIONS
Fast-track TKA and THA do not increase the readmission rate. Readmissions are more frequent after TKA than THA, but dislocation after THA and manipulation after TKA do not increase as LOS is decreasing.
Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark. henrikhusted@dadlnet.dk
Henrik
H
Husted
Kristian Stahl
KS
Otte
Billy B
BB
Kristensen
Thue
T
Orsnes
Henrik
H
Kehlet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy