TY - JOUR
T1 - THA with a minimally invasive technique, multi-modal anesthesia, and home rehabilitation
T2 - Factors associated with early discharge?
AU - Mears, Dana Christopher
AU - Mears, Simon C.
AU - Chelly, Jacques E.
AU - Dai, Feng
AU - Vulakovich, Katie L.
PY - 2009/6
Y1 - 2009/6
N2 - 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.
AB - 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.
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U2 - 10.1007/s11999-009-0785-y
DO - 10.1007/s11999-009-0785-y
M3 - Article
C2 - 19301081
AN - SCOPUS:66349110545
SN - 0009-921X
VL - 467
SP - 1412
EP - 1417
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 6
ER -