Healthy patients who undergo total hip replacement (THR) can be fast tracked to be discharged in two days compared with the standard three to six days, according to a study by researchers at Hospital for Special Surgery (HSS) in New York City. The study could help cut down on hospital-acquired infections, reduce hospital costs and improve patient satisfaction.
The study compared outcomes of patients undergoing THR at HSS. One cohort of 149 patients underwent THR with a fast track protocol. The other cohort of 134 patients underwent THR followed by the hospital's traditional clinical pathway, which aimed to discharge patients at four days at that time.
Patients in the two cohorts were matched for age, sex, body mass index, and comorbidities. Patients on the fast track protocol had a physical therapy session on the day of their surgery. The main difference was that a patient's pain medication was discontinued in the fast track cohort postoperative day one (as long as pain was deemed to be under control), whereas in the traditional cohort, pain medication is usually discontinued on day two.
The investigators found that 58 percent of the fast track cohort was discharged within two days of a THR and 73 percent were discharged within three days. The average discharge time was 2.6 days in the fast track cohort and 4.1 in the traditional cohort. Patients were less likely to be discharged rapidly in the fast track cohort, if they had significant post-operative pain, nausea, or dizziness. At one year, there were no differences in complications, readmissions or reoperation in the two cohorts.
This study demonstrates that a two day discharge is safe and feasible for patients undergoing a total hip replacement. I recommend the fast track protocol for select patients.
Fast Track THR: One Hospital Experience with a 2-Day Length of Stay Protocol for Total Hip Replacement. Gulotta LV, Padgett DE, Sculco TP, Urban M, Lyman S, Nestor BJ. HSS J. 2011 Oct; 7(3): 223-228.