Article

Length of stay (LOS) following total hip and knee
arthroplasty (THA and TKA) has been reduced to about 3 days in fast-track setups
with functional discharge criteria. Earlier studies have identified patient
characteristics predicting LOS, but little is known about specific reasons for
being hospitalized following fast-track THA and TKA. METHODS: To
determine clinical and logistical factors that keep patients in hospital for the
first postoperative 24-72 hours, we performed a cohort study of consecutive,
unselected patients undergoing unilateral primary THA (n = 98) or TKA (n = 109).
Median length of stay was 2 days. Patients were operated with spinal anesthesia
and received multimodal analgesia with paracetamol, a COX-2 inhibitor, and
gabapentin-with opioid only on request. Fulfillment of functional discharge
criteria was assessed twice daily and specified reasons for not allowing
discharge were registered. RESULTS: Pain, dizziness, and general weakness were
the main clinical reasons for being hospitalized at 24 and 48 hours
postoperatively while nausea, vomiting, confusion, and sedation delayed discharge
to a minimal extent. Waiting for blood transfusion (when needed), for start of
physiotherapy, and for postoperative radiographic examination delayed discharge
in one fifth of the patients. INTERPRETATION: Future efforts to enhance recovery
and reduce length of stay after THA and TKA should focus on analgesia, prevention
of orthostatism, and rapid recovery of muscle function.

Langue : ANGLAIS