title: Fast Track THR: One Hospital's Experience with a 2-Day Length of Stay Protocol for Total Hip Replacement.
abstract: BACKGROUND
  Current trends in total joint replacement have focused on shorter hospital stays.
  
  
  OBJECTIVE
  This study aimed to determine if a pathway for total hip replacement (THR) with the goal of a 2-day discharge (fast track) is safe and effective compared to our traditional pathway (control).
  
  
  METHODS
  One hundred forty-nine patients undergoing unilateral, uncomplicated, THR were enrolled in an accelerated postoperative pathway and 134 were enrolled in the traditional pathway. Patients were followed prospectively and outcomes included hospital length of stay, intra- and postoperative complications, readmissions, reoperations. A statistical model was created to determine factors predictive of a 2-day discharge.
  
  
  RESULTS
  At 1 year, there were no differences in complications, readmissions, or reoperations. The average length of stay decreased from 4.1 to 2.6 days (p < 0.0001). In the fast track group, 58% of patients were discharged home within 2 days. Barriers to a 2-day discharge were postoperative pain, nausea, and dizziness. The only preoperative factor that was predictive of a 2-day discharge was hypertension.
  
  
  CONCLUSIONS
  In a select group of patients, a protocol that allows for a 2-day discharge following THR is safe and effective.
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Gulotta
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Padgett
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sculco
authors.forename: Michael
authors.initials: M
authors.lastname: Urban
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Nestor
references.citation: J Am Acad Orthop Surg. 2007 Dec;15(12):707-15
references.pmid: 18063711
references.citation: J Arthroplasty. 2008 Jan;23(1):69-73
references.pmid: 18165032
references.citation: Clin Orthop Relat Res. 2009 Jun;467(6):1443-9
references.pmid: 19238499
references.citation: Clin Orthop Relat Res. 2008 Feb;466(2):424-31
references.pmid: 18196427
references.citation: J Arthroplasty. 2004 Aug;19(5):538-45
references.pmid: 15284972
references.citation: J Arthroplasty. 2003 Dec;18(8):963-7
references.pmid: 14658098
references.citation: Clin Orthop Relat Res. 2005 Jun;(435):232-8
references.pmid: 15930944
references.citation: J Arthroplasty. 2003 Jan;18(1):69-74
references.pmid: 12555186
references.citation: Arthritis Care Res. 1998 Dec;11(6):469-78
references.pmid: 10030179
references.citation: Clin Orthop Relat Res. 2007 Apr;457:133-7
references.pmid: 17065839
references.citation: Clin Orthop Relat Res. 2003 Dec;(417):232-41
references.pmid: 14646722
references.citation: J Arthroplasty. 2004 Jun;19(4):464-8
references.pmid: 15188105
references.citation: J Arthroplasty. 2006 Sep;21(6 Suppl 2):151-6
references.pmid: 16950078
references.citation: Int J Technol Assess Health Care. 1996 Spring;12(2):325-35
references.pmid: 8707504
references.citation: Acta Orthop. 2005 Aug;76(4):555-62
references.pmid: 16195074
references.citation: Health Econ Policy Law. 2006 Jul;1(Pt 3):237-61
references.pmid: 18634695
references.citation: Surg Technol Int. 2004;13:239-47
references.pmid: 15744696
references.citation: Med Care. 2005 Oct;43(10):1018-26
references.pmid: 16166871
references.citation: J Arthroplasty. 2000 Jun;15(4):448-52
references.pmid: 10884204
references.citation: J Arthroplasty. 1998 Feb;13(2):186-90
references.pmid: 9526212
references.citation: J Bone Joint Surg Am. 2004 Nov;86(11):2435-9
references.pmid: 15523015