Enhanced recovery program for hip and knee replacement reduces death rate

Authors

  • Ajay Malviya
  • Kate Martin
  • Ian Harper
  • Scott D Muller
  • Kevin P Emmerson
  • Paul F Partington
  • Mike R Reed

DOI:

https://doi.org/10.3109/17453674.2011.618911

Abstract

Background and purpose Multimodal techniques can aid early rehabilitation and discharge of patients following primary joint replacement. We hypothesized that this not only reduces the economic burden of joint replacement by reducing length of stay, but also helps in reduction of early complications.Patients and methods We evaluated 4,500 consecutive unselected total hip replacements and total knee replacements regarding length of hospital stay, mortality, and perioperative complications. The first 3,000 underwent a traditional protocol while the other 1,500 underwent an enhanced recovery protocol involving behavioral, pharmacological, and procedural modifications.Results There was a reduction in 30-day death rate (0.5% to 0.1%, p = 0.02) and 90-day death rate (0.8% to 0.2%, p = 0.01). The median length of stay decreased from 6 days to 3 days (p (0.8% to 0.5%. p = 0 .2) and stroke (0.5% to 0.2%, p = 0.2). The 60-day deep vein thrombosis figures (0.8% to 0.6%, p = 0.5) and pulmonary embolism figures (1.2% to 1.1%, p = 0.9) were similar. Re-admission rate remained unchanged during the period of the study (4.7% to 4.8%, p = 0.8).Interpretation This large observational study of unselected consecutive hip and knee arthroplasty patients shows a substantial reduction in death rate, reduced length of stay, and reduced transfusion requirements after the introduction of a multimodal enhanced recovery protocol.

Downloads

Download data is not yet available.

Downloads

Published

2011-10-01

How to Cite

Malviya, A., Martin, K., Harper, I., Muller, S. D., Emmerson, K. P., Partington, P. F., & Reed, M. R. (2011). Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthopaedica, 82(5), 577–581. https://doi.org/10.3109/17453674.2011.618911