title: Enhanced recovery program for hip and knee replacement reduces death rate.
abstract: OBJECTIVE
  Multimodal techniques can aid early rehabilitation and discharge of patients following primary joint replacement. We hypothesized that this not only reduces the economic burden of joint replacement by reducing length of stay, but also helps in reduction of early complications.
  
  
  METHODS
  We evaluated 4,500 consecutive unselected total hip replacements and total knee replacements regarding length of hospital stay, mortality, and perioperative complications. The first 3,000 underwent a traditional protocol while the other 1,500 underwent an enhanced recovery protocol involving behavioral, pharmacological, and procedural modifications.
  
  
  RESULTS
  There was a reduction in 30-day death rate (0.5% to 0.1%, p = 0.02) and 90-day death rate (0.8% to 0.2%, p = 0.01). The median length of stay decreased from 6 days to 3 days (p < 0.001), resulting in a saving of 5,418 bed days. Requirement for blood transfusion was reduced (23% to 9.8%, p < 0.001). There was a trend of a reduced rate of 30-day myocardial infarction (0.8% to 0.5%. p = 0 .2) and stroke (0.5% to 0.2%, p = 0.2). The 60-day deep vein thrombosis figures (0.8% to 0.6%, p = 0.5) and pulmonary embolism figures (1.2% to 1.1%, p = 0.9) were similar. Re-admission rate remained unchanged during the period of the study (4.7% to 4.8%, p = 0.8).
  
  
  CONCLUSIONS
  This large observational study of unselected consecutive hip and knee arthroplasty patients shows a substantial reduction in death rate, reduced length of stay, and reduced transfusion requirements after the introduction of a multimodal enhanced recovery protocol.
authors: Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, UK. amalviya@nhs.net
authors: Ajay
authors: A
authors: Malviya
authors: Kate
authors: K
authors: Martin
authors: Ian
authors: I
authors: Harper
authors: Scott D
authors: SD
authors: Muller
authors: Kevin P
authors: KP
authors: Emmerson
authors: Paul F
authors: PF
authors: Partington
authors: Mike R
authors: MR
authors: Reed
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality / Q000534:rehabilitation*; D002985:Clinical Protocols; D019091:Critical Pathways; D004434:Early Ambulation; D006801:Humans; D007902:Length of Stay; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality; D020127:Recovery of Function; D016896:Treatment Outcome