Page 141 - DOS Kongressen 2012 - Abstracts

101.
The role of patient demographics for fast-track hip and knee
replacement. (NB se bort fra submission ID 1775)
Christoffer Joergensen, Henrik Kehlet
Section for Surgical Pathophysiology 4074 Rigshospitalet; Section for Surgical
Pathophysiology 4074, Rigshospitalet Cph.
Background:
Age and co-morbidity have been found to be predictors of
prolonged length of hospital stay (LOS), readmissions and mortality also in
elecetive primary total hip-(THA) and kneearthroplasty (TKA). In this context
the question remains to be answered whether the same applies in fast-track
THA and TKA where LOS is 2- 4 days.
Purpose / Aim of Study:
To evaluate LOS, mortality and readmissions 90
days after fast-track THA and TKA in relation to age and common
demographics.
Materials and Methods:
In 5 wards of the Lundbeck Foundation centre for
fast-track THA and TKA, patients have completed a questionnaire on
demographics and co-morbidity prior to surgery. Data was cross-referenced
with the Danish National Health Registry and medical charts on LOS and
readmissions. Mortality was acquired through The Central Office of Civil
Registration.
Findings / Results:
3112
THA/TKAs were performed in 3020 consecutive
patients. Mean age was 67.3 years (18-97). Median LOS was 3 days and
90.6%
had LOS ¡Ü4 days . Predictors of LOS >4 days were: Age 76-80
(
OR:1.57; CI: 0.99-2.47), 81- 85 (OR: 2.40; CI: 1.45-4.00) and >85 years (OR:
4.10;
CI: 2.15-7.82), CPD(OR: 1.40; CI: 1.03-1.91), preoperative use of
mobility aid (OR: 1.95; CI: 1.46-2.54) and living conditions(OR: 1.92;
CI:1.44-2.54) However, > 80% with these conditions and >75% >80 years had
LOS ¡Ü4days. Mortality and readmission rate was 0.42% and 9.3% in 90 days.
Readmissions were related to age >85 years (OR: 2.16; CI: 1.13-2.10), CPD
(
OR: 1.93; CI: 1.42-2.61) and use of mobility aids (OR: 1.59; CI: 1.17-2.15).
Conclusions:
Fast-track THA and TKA with LOS of ¡Ü4 days is feasible and
safe, also in elderly patients with co-morbidities. Further improvement mosty
focus on surgical technique and perioperative care, especially in patients with
age >85yrs, CPD, using a mobility aid and living alone