Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs - 07/11/19
, Karina Pellei a, François Desmeules a, Vincent Massé a, Christian Loubert b, Martin Lavigne a, Josée Fafard c, Louis-Philippe Fortier b
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Abstract |
Introduction |
An attractive option to reduce hospital length of stay (LOS) after hip or knee joint replacement (THA, TKA) is to follow the Enhanced Recovery After Surgery principles (ERAS) to improve patient experience to a level where they will feel confident to leave for home earlier. The objective of this study was to evaluate the implementation of short-stay protocol following the ERAS principles.
Hypothesis |
We hypothesized that our ERAS THA and TKA short-stay protocol would result in a lower complication rate, shorter hospital LOS and reduced direct health care costs compared to our standard procedure.
Material and methods |
We compared the complications rated according to Clavien-Dindo scale, hospital LOS and costs of the episode of care between a prospective cohort of 120 ERAS short-stay THA or TKA and a matched historical control group of 150 THA or TKA.
Results |
Significantly lower rate of Grade 1 and 2 complications in the ERAS short-stay group compared with the standard group (mean 0.8 vs 3.0, p<0.001). No difference was found between the 2 groups for Grade 3, 4, or 5 complications. The mean hospital LOS for the ERAS short-stay group decreased by 2.8 days for the THAs (0.1 vs 2.9 days, p<0.001) and 3.9 days for the TKAs (1.0 vs 4.9 days, p<0.001). The mean estimated direct health care costs reduction with the ERAS short-stay protocol was 1489 CAD per THA and 4158 CAD per TKA.
Discussion |
In many short-stay protocols, focus has shifted from ERAS goals of a reduction in complications and improved recuperation to use length of stay as the main factor of success. Implementation of an ERAS short-stay protocol for patients undergoing THA or TKA at our institution resulted not only in reduced hospital LOS, but also in improved patient care and reduced direct health care costs.
Level of evidence |
Level II.
El texto completo de este artículo está disponible en PDF.Keywords : Day surgery, Enhanced recovery after surgery, Hip arthroplasty, Knee arthroplasty, Complication, Cost
Esquema
Vol 105 - N° 7
P. 1237-1243 - novembre 2019 Regresar al número
Artículo precedente
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- Does performing outpatient total hip arthroplasty contribute to early complications and readmissions? Retrospective case-control study of 50 patients
- Charlotte Crampet, Harold Common, Emma Bajeux, Antoine Bourgoin, Hervé Thomazeau, Jean-Louis Polard, Orthopedics, Traumatology Society of Western France
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.