title: Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009: from research to implementation.
abstract: BACKGROUND
  Fast-track surgery is the combination of optimized clinical and organizational factors aiming at reducing convalescence and perioperative morbidity including the functional recovery resulting in reduced hospitalization. As the previous nationwide studies have demonstrated substantial variations in length of stay (LOS) following standardized operations such as total hip and knee arthroplasty (THA and TKA), this nationwide study was undertaken to evaluate the implementation process of fast-track THA and TKA in Denmark.
  
  
  METHODS
  All hospitals in Denmark report to the National Patient Registry, linking the type of surgery and LOS with a unique individual social security number. This study is based on primary THA and TKA from a 5.5 million population from 2000 to the end of 2009.
  
  
  RESULTS
  The number of performed primary unilateral THA and TKA has increased from around 7,200 in 2000 to 13,800 in 2009 with a concomitant reduction in LOS from median 10-11 days in 2000 to 4 days in 2009.
  
  
  CONCLUSIONS
  Fast-track surgery has been successfully implemented in the orthopedic departments in Denmark through a multi-disciplinary educational and multi-institutional effort. These implementation principles may be transferred to other countries and other specialties.
authors.affiliation: Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark. henrikhusted@dadlnet.dk
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
authors.forename: Claus Munk
authors.initials: CM
authors.lastname: Jensen
authors.forename: Søren
authors.initials: S
authors.lastname: Solgaard
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000592:standards* / Q000639:trends; D019645:Arthroplasty, Replacement, Knee / Q000592:standards* / Q000639:trends; D003718:Denmark; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement; D012042:Registries