title: Older patients have the most to gain from orthopaedic enhanced recovery programmes.
abstract: BACKGROUND
  Between August 2007 and May 2009, 2128 consecutive patients underwent either primary hip or knee joint replacement surgery at our institute on an enhanced recovery pathway. We aimed to investigate the potential benefits of this pathway in patients over the age of 85 years.
  
  
  METHODS
  Data extracted from Hospital Episode Statistics were analysed. This data are prospectively collected and independently collated.
  
  
  RESULTS
  In all patients median length of stay was reduced when compared with both our own data before the introduction of the pathway (6 to 4 days) and national averages over the same time period for both hip and knee replacements (5 to 4 days). Difference in length of stay was most pronounced in the group of patients aged 85 years and over (9 to 5 days for total hip replacement and 8 to 5 days for total knee replacement). Nearly all patients were discharged directly home (97.4%). Readmission rates were over 45% lower in patients aged 85 and over when compared with national averages (5.2 vs. 9.4%).
  
  
  CONCLUSIONS
  This is the first series in the literature to assess the role of enhanced recovery pathways in the very elderly. This study not only shows that successful fast track rehabilitation can be achieved in the very elderly population undergoing elective joint replacement surgery, but that it is this cohort of vulnerable patients who have the most to gain from such multidisciplinary recovery programmes.
authors.affiliation: Orthopaedic Department, Wrexham Maelor Hospital, Wrexham, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Starks
authors.affiliation: Orthopaedic Department, The Royal Bournemouth Hospital, Bournemouth, UK Centre of Postgraduate Medicine, Research and Education, The School of Health and Social Care, Bournemouth University, Bournemouth, UK.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wainwright
authors.affiliation: Lead Research Analyst at Dr Foster Intelligence London, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Orthopaedic Department, The Royal Bournemouth Hospital, Bournemouth, UK.
authors.forename: John
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Orthopaedic Department, The Royal Bournemouth Hospital, Bournemouth, UK Centre of Postgraduate Medicine, Research and Education, The School of Health and Social Care, Bournemouth University, Bournemouth, UK.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Middleton
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D004434:Early Ambulation; D004739:England; D006801:Humans; D007902:Length of Stay; D010351:Patient Discharge; D010359:Patient Readmission; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods*; D015397:Program Evaluation; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: elderly; enhanced; older people; orthopaedic; recovery