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Erschienen in: Archives of Orthopaedic and Trauma Surgery 1/2012

01.01.2012 | Orthopaedic Outcome Assessment

Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation

verfasst von: Henrik Husted, Claus Munk Jensen, Søren Solgaard, Henrik Kehlet

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2012

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Abstract

Introduction

Fast-track surgery is the combination of optimized clinical and organizational factors aiming at reducing convalescence and perioperative morbidity including the functional recovery resulting in reduced hospitalization. As the previous nationwide studies have demonstrated substantial variations in length of stay (LOS) following standardized operations such as total hip and knee arthroplasty (THA and TKA), this nationwide study was undertaken to evaluate the implementation process of fast-track THA and TKA in Denmark.

Materials and methods

All hospitals in Denmark report to the National Patient Registry, linking the type of surgery and LOS with a unique individual social security number. This study is based on primary THA and TKA from a 5.5 million population from 2000 to the end of 2009.

Results

The number of performed primary unilateral THA and TKA has increased from around 7,200 in 2000 to 13,800 in 2009 with a concomitant reduction in LOS from median 10–11 days in 2000 to 4 days in 2009.

Conclusion

Fast-track surgery has been successfully implemented in the orthopedic departments in Denmark through a multi-disciplinary educational and multi-institutional effort. These implementation principles may be transferred to other countries and other specialties.
Literatur
1.
Zurück zum Zitat Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617PubMed Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617PubMed
2.
Zurück zum Zitat Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198PubMedCrossRef Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198PubMedCrossRef
4.
Zurück zum Zitat Husted H, Otte KS, Kristensen BB, Ørsnes T, Kehlet H (2010) Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg 130:1185–1191PubMedCrossRef Husted H, Otte KS, Kristensen BB, Ørsnes T, Kehlet H (2010) Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg 130:1185–1191PubMedCrossRef
5.
Zurück zum Zitat Husted H, Otte KS, Kristensen BB, Ørsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605PubMedCrossRef Husted H, Otte KS, Kristensen BB, Ørsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605PubMedCrossRef
6.
Zurück zum Zitat Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130:263–268PubMedCrossRef Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130:263–268PubMedCrossRef
7.
Zurück zum Zitat Husted H, Hansen HC, Holm G (2006) Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction. Ugeskr Laeger 168:2148–2151PubMed Husted H, Hansen HC, Holm G (2006) Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction. Ugeskr Laeger 168:2148–2151PubMed
10.
Zurück zum Zitat Jimenez-Garcıa R, Villanueva-Martınez M, Fernandez-de-Las-Penas C, Hernandez-Barrera V, Rıos-Luna A, Garrido PC, de Andres AL, Jimenez-Trujillo I, Montero JS, Gil-de-Miguel A (2011) Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality. BMC Musculoskelet Disord 12:43PubMedCrossRef Jimenez-Garcıa R, Villanueva-Martınez M, Fernandez-de-Las-Penas C, Hernandez-Barrera V, Rıos-Luna A, Garrido PC, de Andres AL, Jimenez-Trujillo I, Montero JS, Gil-de-Miguel A (2011) Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality. BMC Musculoskelet Disord 12:43PubMedCrossRef
11.
Zurück zum Zitat Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Length of stay in total hip and knee arthroplasty in Denmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark. Ugeskr Laeger 168:2139–2143PubMed Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Length of stay in total hip and knee arthroplasty in Denmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark. Ugeskr Laeger 168:2139–2143PubMed
12.
Zurück zum Zitat Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences. Ugeskr Laeger 168:2144–2148PubMed Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2006) Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences. Ugeskr Laeger 168:2144–2148PubMed
13.
Zurück zum Zitat Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173PubMedCrossRef Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173PubMedCrossRef
14.
Zurück zum Zitat Andersen SH, Husted H, Kehlet H (2009) Economic consequences of accelerated care pathways in total knee-arthroplasty. Ugeskr Laeger 171:3276–3280PubMed Andersen SH, Husted H, Kehlet H (2009) Economic consequences of accelerated care pathways in total knee-arthroplasty. Ugeskr Laeger 171:3276–3280PubMed
15.
Zurück zum Zitat Rud K, Jakobsen DH, Egerod I, Kehlet H (2008) Surgical care guidelines. Ugeskr Laeger 170:1559–1563PubMed Rud K, Jakobsen DH, Egerod I, Kehlet H (2008) Surgical care guidelines. Ugeskr Laeger 170:1559–1563PubMed
17.
Zurück zum Zitat Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H (2011) Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg (Br) 93:351–356CrossRef Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H (2011) Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg (Br) 93:351–356CrossRef
18.
Zurück zum Zitat Husted H, Otte KS, Kristensen BB, Kehlet H (2011) Fast-track revision knee arthroplasty : a feasibility study. Acta Orthop 82(4):438–440 Husted H, Otte KS, Kristensen BB, Kehlet H (2011) Fast-track revision knee arthroplasty : a feasibility study. Acta Orthop 82(4):438–440
19.
Zurück zum Zitat Khan F, Ng L, Gonzalez S, Hale T, Turner-Stokes L (2008) Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 16(2):CD004957 Khan F, Ng L, Gonzalez S, Hale T, Turner-Stokes L (2008) Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 16(2):CD004957
20.
Zurück zum Zitat Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation - is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54PubMedCrossRef Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation - is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54PubMedCrossRef
22.
Zurück zum Zitat Husted H, Solgaard S, Hansen TB, Søballe K, Kehlet H (2010) Care principles at four fast-track arthroplasty departments in Denmark. Dan Med Bull 57:A4166PubMed Husted H, Solgaard S, Hansen TB, Søballe K, Kehlet H (2010) Care principles at four fast-track arthroplasty departments in Denmark. Dan Med Bull 57:A4166PubMed
23.
Zurück zum Zitat Kehlet H, Andersen LØ (2011) Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice? Acta Anaesthesiol Scand 55(7):778–784 Kehlet H, Andersen LØ (2011) Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice? Acta Anaesthesiol Scand 55(7):778–784
24.
Zurück zum Zitat Kehlet H, Søballe K (2010) Fast-track hip and knee replacement - what are the issues? Acta Orthop 81:271–272PubMedCrossRef Kehlet H, Søballe K (2010) Fast-track hip and knee replacement - what are the issues? Acta Orthop 81:271–272PubMedCrossRef
25.
Zurück zum Zitat Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H (2009) Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 64:508–513PubMedCrossRef Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H (2009) Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 64:508–513PubMedCrossRef
26.
Zurück zum Zitat Krenk L, Rasmussen LS, Kehlet H (2010) New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 54:951–956PubMedCrossRef Krenk L, Rasmussen LS, Kehlet H (2010) New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 54:951–956PubMedCrossRef
Metadaten
Titel
Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation
verfasst von
Henrik Husted
Claus Munk Jensen
Søren Solgaard
Henrik Kehlet
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2012
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-011-1396-0

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