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 journalArticle

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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