THA with a minimally invasive technique, multi-modal anesthesia, and home rehabilitation: Factors associated with early discharge?

Dana Christopher Mears, Simon C. Mears, Jacques E. Chelly, Feng Dai, Katie L. Vulakovich

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1412-1417
Number of pages6
JournalClinical orthopaedics and related research
Volume467
Issue number6
DOIs
StatePublished - Jun 2009

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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