THA with a Minimally Invasive Technique, Multi-modal Anesthesia, and Home Rehabilitation: Factors Associated with Early Discharge?
- 20 March 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research®
- Vol. 467 (6), 1412-1417
- https://doi.org/10.1007/s11999-009-0785-y
Abstract
Multimodal anesthetic and pain regimens with minimally invasive surgical approaches and rapid rehabilitation protocols are thought to decrease length of stay after hip replacement. We asked whether a program including these three elements could achieve 23-hour discharge in a group of 665 patients and whether the length of hospital stay was influenced by patient age, gender, body mass index, change in hemoglobin or estimated blood loss, duration of surgery (≤ 90 or > 90 minutes), or American Society of Anesthesiologists physical status classification. Of the 665 patients, 259 (38.9%) were discharged home with indwelling peripheral nerve catheters. Hospital discharge in less than 24 hours was achieved in 295 (44.4%) of the 665 patients. After discharge, 73.5% of patients required no home or outpatient nursing care or physical therapy. Eighteen (2.7%) dislocations, eight (1.2%) femoral fractures requiring surgery, and thirteen (2.0%) revision procedures occurred within 90 days. Female gender, increasing age, increasing estimated blood loss, and American Association of Anesthesiologists classification 3 or 4 increased length of stay. Additional study is needed to confirm these factors and develop prospective prediction rules to allow for an outpatient approach to joint arthroplasty. Level of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Keywords
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