title: Why still in hospital after fast-track hip and knee arthroplasty?
abstract: OBJECTIVE
  Length of stay (LOS) following total hip and knee arthroplasty (THA and TKA) has been reduced to about 3 days in fast-track setups with functional discharge criteria. Earlier studies have identified patient characteristics predicting LOS, but little is known about specific reasons for being hospitalized following fast-track THA and TKA.
  
  
  METHODS
  To determine clinical and logistical factors that keep patients in hospital for the first postoperative 24-72 hours, we performed a cohort study of consecutive, unselected patients undergoing unilateral primary THA (n = 98) or TKA (n = 109). Median length of stay was 2 days. Patients were operated with spinal anesthesia and received multimodal analgesia with paracetamol, a COX-2 inhibitor, and gabapentin-with opioid only on request. Fulfillment of functional discharge criteria was assessed twice daily and specified reasons for not allowing discharge were registered.
  
  
  RESULTS
  Pain, dizziness, and general weakness were the main clinical reasons for being hospitalized at 24 and 48 hours postoperatively while nausea, vomiting, confusion, and sedation delayed discharge to a minimal extent. Waiting for blood transfusion (when needed), for start of physiotherapy, and for postoperative radiographic examination delayed discharge in one fifth of the patients.
  
  
  CONCLUSIONS
  Future efforts to enhance recovery and reduce length of stay after THA and TKA should focus on analgesia, prevention of orthostatism, and rapid recovery of muscle function.
authors: Department of Orthopaedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark. henrikhusted@dadlnet.dk
authors: Henrik
authors: H
authors: Husted
authors: Troels H
authors: TH
authors: Lunn
authors: Anders
authors: A
authors: Troelsen
authors: Lissi
authors: L
authors: Gaarn-Larsen
authors: Billy B
authors: BB
authors: Kristensen
authors: Henrik
authors: H
authors: Kehlet
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D015331:Cohort Studies; D004434:Early Ambulation; D006801:Humans; D007902:Length of Stay; D010351:Patient Discharge; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D020127:Recovery of Function; D013997:Time Factors