title: Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications.
abstract: OBJECTIVE
  To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates.
  
  
  METHODS
  Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups.
  
  
  RESULTS
  Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months.
  
  
  CONCLUSIONS
  There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates.
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España. Electronic address: cwilches@csa.cat.
authors.forename: C
authors.initials: C
authors.lastname: Wilches
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
authors.forename: J D
authors.initials: JD
authors.lastname: Sulbarán
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
authors.forename: J E
authors.initials: JE
authors.lastname: Fernández
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Gisbert
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Bausili
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
authors.forename: X
authors.initials: X
authors.lastname: Pelfort
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
keywords: Artroplastia total de cadera; Artroplastia total de rodilla; Fast-track recovery; Rapid recovery; Recuperación fast-track; Recuperación rápida; Total hip replacement; Total knee replacement