Discharge Destination of Patients in Fast-Track Primary Hip and Knee Arthroplasty: Results From a Prospective Danish Cohort

Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the redu...

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Veröffentlicht in:	The Journal of arthroplasty Jg. 40; H. 7; S. 1690 - 1695
Hauptverfasser:	Lyndrup, Oliver, Kehlet, Henrik, Jørgensen, Christoffer C., Lindberg-Larsen, Martin, Jakobsen, Thomas, Gromov, Kirill, Andersen, Mikkel R., Bieder, Manuel, Overgaard, Søren, Varnum, Claus
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Elsevier Inc 01.07.2025
Schlagworte:	Aged Aged, 80 and over Arthroplasty, Replacement, Hip - rehabilitation Arthroplasty, Replacement, Knee - rehabilitation Denmark discharge destination fast-track surgery Female Humans Length of Stay - statistics & numerical data Male Middle Aged Patient Discharge - statistics & numerical data Prospective Studies Rehabilitation Centers - statistics & numerical data rehabilitation facility total hip arthroplasty total knee arthroplasty unicompartmental knee arthroplasty Denmark fast-track surgery total hip arthroplasty total knee arthroplasty discharge destination rehabilitation facility unicompartmental knee arthroplasty
ISSN:	0883-5403, 1532-8406, 1532-8406
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Abstract	Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the reduction in LOS is at the expense of an increase in nonhome discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients. The prospective multicenter study included 6,856 patients undergoing primary THA, TKA, and UKA in a fast-track setting with an overall median LOS of one day. Outcomes were discharge destination, median LOS in each discharge destination category, and cause of rehabilitation center discharge. Data were gathered using preoperative questionnaires and a review of medical records. Discharge destination and LOS were registered at discharge. We found that 99% of patients had been discharged to their own homes, of which 21% had been discharged to their own homes with home care. There were 1% who were discharged to a rehabilitation facility and 0.1% who were discharged to a nursing home. The THA (1%, 95% confidence interval [CI] 0.7 to 1) and TKA (1%, 95% CI 0.9 to 2) had a significantly higher rate of discharge to a rehabilitation facility compared to UKA (0.1%, 95% CI 0.0 to 0.5). Despite a short LOS, 99% of patients were discharged to their own homes. Rehabilitation facility discharge was only 1% and was mostly caused by inadequate postoperative mobilization.
AbstractList	Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the reduction in LOS is at the expense of an increase in nonhome discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients. The prospective multicenter study included 6,856 patients undergoing primary THA, TKA, and UKA in a fast-track setting with an overall median LOS of one day. Outcomes were discharge destination, median LOS in each discharge destination category, and cause of rehabilitation center discharge. Data were gathered using preoperative questionnaires and a review of medical records. Discharge destination and LOS were registered at discharge. We found that 99% of patients had been discharged to their own homes, of which 21% had been discharged to their own homes with home care. There were 1% who were discharged to a rehabilitation facility and 0.1% who were discharged to a nursing home. The THA (1%, 95% confidence interval [CI] 0.7 to 1) and TKA (1%, 95% CI 0.9 to 2) had a significantly higher rate of discharge to a rehabilitation facility compared to UKA (0.1%, 95% CI 0.0 to 0.5). Despite a short LOS, 99% of patients were discharged to their own homes. Rehabilitation facility discharge was only 1% and was mostly caused by inadequate postoperative mobilization. Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the reduction in LOS is at the expense of an increase in nonhome discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients.BACKGROUNDFollowing the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the reduction in LOS is at the expense of an increase in nonhome discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients.The prospective multicenter study included 6,856 patients undergoing primary THA, TKA, and UKA in a fast-track setting with an overall median LOS of one day. Outcomes were discharge destination, median LOS in each discharge destination category, and cause of rehabilitation center discharge. Data were gathered using preoperative questionnaires and a review of medical records. Discharge destination and LOS were registered at discharge.METHODSThe prospective multicenter study included 6,856 patients undergoing primary THA, TKA, and UKA in a fast-track setting with an overall median LOS of one day. Outcomes were discharge destination, median LOS in each discharge destination category, and cause of rehabilitation center discharge. Data were gathered using preoperative questionnaires and a review of medical records. Discharge destination and LOS were registered at discharge.We found that 99% of patients had been discharged to their own homes, of which 21% had been discharged to their own homes with home care. There were 1% who were discharged to a rehabilitation facility and 0.1% who were discharged to a nursing home. The THA (1%, 95% confidence interval [CI] 0.7 to 1) and TKA (1%, 95% CI 0.9 to 2) had a significantly higher rate of discharge to a rehabilitation facility compared to UKA (0.1%, 95% CI 0.0 to 0.5).RESULTSWe found that 99% of patients had been discharged to their own homes, of which 21% had been discharged to their own homes with home care. There were 1% who were discharged to a rehabilitation facility and 0.1% who were discharged to a nursing home. The THA (1%, 95% confidence interval [CI] 0.7 to 1) and TKA (1%, 95% CI 0.9 to 2) had a significantly higher rate of discharge to a rehabilitation facility compared to UKA (0.1%, 95% CI 0.0 to 0.5).Despite a short LOS, 99% of patients were discharged to their own homes. Rehabilitation facility discharge was only 1% and was mostly caused by inadequate postoperative mobilization.CONCLUSIONSDespite a short LOS, 99% of patients were discharged to their own homes. Rehabilitation facility discharge was only 1% and was mostly caused by inadequate postoperative mobilization.
Author	Gromov, Kirill Jakobsen, Thomas Varnum, Claus Jørgensen, Christoffer C. Lindberg-Larsen, Martin Overgaard, Søren Lyndrup, Oliver Andersen, Mikkel R. Bieder, Manuel Kehlet, Henrik
Author_xml	– sequence: 1 givenname: Oliver surname: Lyndrup fullname: Lyndrup, Oliver organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 2 givenname: Henrik surname: Kehlet fullname: Kehlet, Henrik organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 3 givenname: Christoffer C. surname: Jørgensen fullname: Jørgensen, Christoffer C. organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 4 givenname: Martin surname: Lindberg-Larsen fullname: Lindberg-Larsen, Martin organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 5 givenname: Thomas surname: Jakobsen fullname: Jakobsen, Thomas organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 6 givenname: Kirill surname: Gromov fullname: Gromov, Kirill organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 7 givenname: Mikkel R. surname: Andersen fullname: Andersen, Mikkel R. organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 8 givenname: Manuel surname: Bieder fullname: Bieder, Manuel organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 9 givenname: Søren surname: Overgaard fullname: Overgaard, Søren organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark – sequence: 10 givenname: Claus surname: Varnum fullname: Varnum, Claus organization: Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/39653131$$D View this record in MEDLINE/PubMed
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Keywords	fast-track surgery total hip arthroplasty total knee arthroplasty discharge destination rehabilitation facility unicompartmental knee arthroplasty
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Snippet	Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty...
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SubjectTerms	Aged Aged, 80 and over Arthroplasty, Replacement, Hip - rehabilitation Arthroplasty, Replacement, Knee - rehabilitation Denmark discharge destination fast-track surgery Female Humans Length of Stay - statistics & numerical data Male Middle Aged Patient Discharge - statistics & numerical data Prospective Studies Rehabilitation Centers - statistics & numerical data rehabilitation facility total hip arthroplasty total knee arthroplasty unicompartmental knee arthroplasty
Title	Discharge Destination of Patients in Fast-Track Primary Hip and Knee Arthroplasty: Results From a Prospective Danish Cohort
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