title: Telemedicine support shortens length of stay after fast-track hip replacement.
abstract: Background and purpose - Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement. Patients and methods - We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery. Results - Length of stay was reduced from 2.1 days (95% CI: 2.0-2.3) to 1.1 day (CI: 0.9-1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group. Interpretation - Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement.
authors.affiliation: a INNO-X Healthcare, Aarhus University.|e Department of Clinical Medicine , Aarhus University , Denmark .
authors.forename: Martin Svoldgaard
authors.initials: MS
authors.lastname: Vesterby
authors.affiliation: c Department of Health Science and Technology, Faculty of Medicine , Aalborg University.
authors.forename: Preben Ulrich
authors.initials: PU
authors.lastname: Pedersen
authors.affiliation: b Center for Elective Surgery , Silkeborg Regional Hospital.
authors.forename: Malene
authors.initials: M
authors.lastname: Laursen
authors.affiliation: b Center for Elective Surgery , Silkeborg Regional Hospital.
authors.forename: Søren
authors.initials: S
authors.lastname: Mikkelsen
authors.affiliation: b Center for Elective Surgery , Silkeborg Regional Hospital.|e Department of Clinical Medicine , Aarhus University , Denmark .
authors.forename: Jens
authors.initials: J
authors.lastname: Larsen
authors.affiliation: d Department of Orthopaedic Surgery , Aarhus University Hospital.|e Department of Clinical Medicine , Aarhus University , Denmark .
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
authors.affiliation: b Center for Elective Surgery , Silkeborg Regional Hospital.|e Department of Clinical Medicine , Aarhus University , Denmark .
authors.forename: Lene Bastrup
authors.initials: LB
authors.lastname: Jørgensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D017216:Telemedicine; D013997:Time Factors