title: Total joint arthroplasty cost savings with a rapid recovery protocol in a military medical center.
abstract: The reported short-term benefits of rapid recovery protocols for total joint arthroplasty primarily come from specialized centers of excellence. The feasibility of achieving similar benefits at a military health care facility has not been reported. The authors hypothesized that application of such a protocol in this setting would decrease hospital stay and costs. A retrospective study was conducted comparing 85 hip and knee replacements by one surgeon using conventional protocol to 90 cases by a second surgeon using a rapid recovery protocol in the same hospital. Outcome measures included operative time, length of hospital stay, pain at discharge, use of inpatient rehabilitation facilities, complications requiring readmission, and inpatient admission costs. The results showed decreased length of stay by 2.9 days (p < 0.001) in the rapid recovery group, resulting in average cost savings of $1,511 (p < 0.001) with shorter operative time, equivalent pain at discharge, and fewer discharges to rehabilitation facilities. This feasibility study shows promising results, but prospective randomized trials are necessary to draw firm conclusions on the superiority of a rapid recovery protocol for total hip and knee arthroplasty in a military medical system.
authors.affiliation: Department of Orthopedics & Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Doman
authors.forename: Tad L
authors.initials: TL
authors.lastname: Gerlinger
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000534:rehabilitation*; D017046:Cost Savings; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology