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

Oliver Lyndrup; Henrik Kehlet; Christoffer C Jørgensen; Martin Lindberg-Larsen; Thomas Jakobsen; Kirill Gromov; Mikkel R Andersen; Manuel Bieder; Søren Overgaard; Claus Varnum

doi:10.1016/j.arth.2024.12.005

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

J Arthroplasty. 2024 Dec 7:S0883-5403(24)01285-3. doi: 10.1016/j.arth.2024.12.005. Online ahead of print.

Authors

Affiliations

¹ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery, Lillebaelt Hospital - Vejle, Region of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark. Electronic address: Oliver.lyndrup@rsyd.dk.
² Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark.
³ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Anaesthesia, Hospital of Northern Zeeland, Capital Region, Dyrehavevej 29, 3400, Hillerød, Denmark.
⁴ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery and traumatology, Odense University Hospital and Svendborg.
⁵ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery, Aalborg University Hospital.
⁶ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery, Hvidovre University Hospital, Capital Region, Kettegård Allé 30, 2650 Hvidovre, Denmark.
⁷ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery, Copenhagen University Hospital, Herlev-Gentofte.
⁸ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic surgery, Næstved, Slagelse and Ringsted Hospitals.
⁹ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg.
¹⁰ Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Capital Region, Blegdamsvej 9, 2100, Copenhagen, Denmark; Dept. of Orthopaedic Surgery, Lillebaelt Hospital - Vejle, Region of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.

PMID: 39653131
DOI: 10.1016/j.arth.2024.12.005

Abstract

Background: 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 non-home discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Discharge destination; Fast-track surgery; Rehabilitation facility; Total hip arthroplasty; Total knee arthroplasty; Unicompartmental knee arthroplasty.