Fast track surgery protocol for total joint arthroplast

Abstract

Background and objectives: Safe and effective clinical pathway is needed for the growing numbers of patients for joint arthroplasty in our hospital. Our primary objective was to deter- mine whether implementing a new protocol can reduce length of hospital stay of the patients for total hip or knee arthroplasty while maintaining patient safety, without increasing perioperative complications. Methods: In this retrospective-prospective study, 61 patients for total hip or knee arthroplasty, are treated according to the new multidisciplinary protocol (prospectively) and compared to 61 patients treated with a standard one (retrospectively). The new protocol emphasizes preoperative patient education, postoperative multimodal analgesia, pre and postoperative use of tranexamic acid, early mobilization and rehabilitation. The primary outcome was the number of hospital days. Secondary outcomes were concerned with patient safety and involved evaluating postoperative side effects, complications, number of blood transfusions and pain scores. Results: The number of hospital days was reduced for the patients in the new protocol com- pared with the standard protocol. There was a statistically significant difference with the pain scores in favor of the new protocol in all six measurement times. Significantly more patients received blood transfusion intra and postoperatively with the standard protocol compared to the patients in the fast track protocol. There was no significant difference between the two groups in the rate and severity of complications. Conclusion: Multidisciplinary approach in forming a clinical pathway in total joint arthro- plasty reduces length of hospital stay without increasing the complication rate.