PMID- 31474350
OWN - NLM
STAT- MEDLINE
DCOM- 20191024
LR  - 20191024
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 123
IP  - 5
DP  - 2019 Nov
TI  - Days alive and out of hospital after fast-track total hip and knee arthroplasty: 
      an observational cohort study in 16 137 patients.
PG  - 671-678
LID - S0007-0912(19)30599-9 [pii]
LID - 10.1016/j.bja.2019.07.022 [doi]
AB  - BACKGROUND: Days alive and out of hospital (DAH) has been proposed as a pragmatic 
      outcome measure of surgical quality. However, there is a lack of procedure 
      specific data or data within an optimised fast-track protocol. Furthermore, 
      information about influence of follow-up duration and types of complications on 
      DAH is limited. METHODS: Observational multicentre cohort study of patients 
      undergoing fast-track total hip (THA) and knee arthroplasty (TKA). Prospective 
      information on comorbidity and complete 90 days follow-up was undertaken through 
      the Danish National Patient Register and chart review. RESULTS: For 16 137 
      procedures, of which 18.6% were high-risk (>/=2 preoperative risk factors), the 
      median length of stay was 2 days (inter-quartile range [IQR], 2-3), and 30- and 
      90-day readmission rates were 5.7% and 8.1%, respectively. Median DAH(30) and 
      DAH(90) days were 27 (26-28) and 87 (85-88) vs 28 (27-28) and 88 (87-89) 
      (P<0.001) in high-vs low-risk patients, respectively. The fraction with DAH </=25 
      at 30 days and DAH </=85 at 90 days was increased in high-vs low-risk patients: 
      23.3% vs 6.8% (odds ratio [OR]=4.16; 95% confidence interval [CI], 3.73-4.65) and 
      26.0% vs 8.6% (OR=3.75; 95% CI, 3.38-4.16). There were relatively fewer 
      'surgical' complications in high- vs low-risk patients with DAH(30) </=25 (14.6% vs 
      25.8%) (OR=0.49; 95% CI, 0.37-0.65) and DAH(90) </=85 (16.9% vs 31.89%) (OR=0.43; 
      95% CI, 0.34-0.56). About 2% of patients had readmissions, but DAH was >25 and 
      >85 at 30 and 90 days after operation, respectively. CONCLUSION: Median DAH in 
      fast-track THA/TKA patients is 28 at 30 days and 88 at 90 days after surgery. DAH 
      in high-risk patients was only slightly reduced compared with low-risk patients, 
      but they have relatively more 'medical' complications.
CI  - Copyright (c) 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Jorgensen, Christoffer C
AU  - Jorgensen CC
AD  - Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, 
      Copenhagen, Denmark; Lundbeck Foundation Centre for Fast-track Hip and Knee 
      Replacement, Copenhagen, Denmark. Electronic address: 
      Christoffer.calov.joergensen@regionh.dk.
FAU - Petersen, Pelle B
AU  - Petersen PB
AD  - Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, 
      Copenhagen, Denmark; Lundbeck Foundation Centre for Fast-track Hip and Knee 
      Replacement, Copenhagen, Denmark.
FAU - Kehlet, Henrik
AU  - Kehlet H
AD  - Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, 
      Copenhagen, Denmark; Lundbeck Foundation Centre for Fast-track Hip and Knee 
      Replacement, Copenhagen, Denmark.
CN  - Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative 
      Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20190829
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Aged
MH  - Arthroplasty, Replacement, Hip/adverse effects/*mortality/standards
MH  - Arthroplasty, Replacement, Knee/adverse effects/*mortality/standards
MH  - Cohort Studies
MH  - Comorbidity
MH  - Denmark/epidemiology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Patient Readmission/statistics & numerical data
MH  - Postoperative Complications/mortality
MH  - Postoperative Period
MH  - Quality Indicators, Health Care
MH  - Registries
MH  - Risk Factors
OTO - NOTNLM
OT  - enhanced recovery
OT  - fast-track surgery
OT  - hip replacement
OT  - knee replacement
OT  - perioperative medicine
OT  - postoperative outcomes
FIR - Madsen, Frank
IR  - Madsen F
IRAD- Department of Orthopedics, Aarhus University Hospital, Aarhus University, Aarhus, 
      Denmark.
FIR - Hansen, Torben B
IR  - Hansen TB
IRAD- Department of Orthopedics, Regional Hospital Holstebro, Aarhus University, 
      Aarhus, Denmark.
FIR - Husted, Henrik
IR  - Husted H
IRAD- Orthopedic Department, Hvidovre University Hospital, University of Copenhagen, 
      Copenhagen, Denmark.
FIR - Laursen, Mogens
IR  - Laursen M
IRAD- Orthopedic Division, Aalborg Hospital, Aalborg University, Aalborg, Denmark.
FIR - Hansen, Lars T
IR  - Hansen LT
IRAD- Orthopedic Department, Sydvestjysk Hospital Esbjerg/Grindsted, Esbjerg, Denmark.
FIR - Kjaersgaard-Andersen, Per
IR  - Kjaersgaard-Andersen P
IRAD- Department of Orthopedics, Vejle Hospital, University of Southern Denmark,Odense, 
      Denmark.
FIR - Solgaard, Soren
IR  - Solgaard S
IRAD- Department of Orthopedics, Gentofte University Hospital, Hellerup, Denmark.
FIR - Jorn, Lars Peter
IR  - Jorn LP
IRAD- Department of Orthopedics, Viborg Hospital, Viborg, Denmark.
EDAT- 2019/09/03 06:00
MHDA- 2019/10/28 06:00
CRDT- 2019/09/03 06:00
PHST- 2019/02/25 00:00 [received]
PHST- 2019/07/10 00:00 [revised]
PHST- 2019/07/29 00:00 [accepted]
PHST- 2019/09/03 06:00 [pubmed]
PHST- 2019/10/28 06:00 [medline]
PHST- 2019/09/03 06:00 [entrez]
AID - S0007-0912(19)30599-9 [pii]
AID - 10.1016/j.bja.2019.07.022 [doi]
PST - ppublish
SO  - Br J Anaesth. 2019 Nov;123(5):671-678. doi: 10.1016/j.bja.2019.07.022. Epub 2019 
      Aug 29.