Reasons for Delayed Discharge after Total Knee Arthroplasty under Fast-track Recovery Model_West China Medical Journal

Authors：

 TuXiaoqing ,  NingNing , ChenZhonglan , HouXiaoling , ChenJiali

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

NingNing, Email: gkningning@126.com

Keywords：

Fast-track recovery model; Total knee arthroplasty; Perioperative management

DOI：

10.7507/1002-0179.201600201

Video：

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Objective To illustrate the situation of delayed discharge of patients after total knee arthroplasty (TKA) under fast-track (FT) recovery model, and analyze the reasons. Methods We retrospectively analyzed the clinical data of 152 patients who accepted perioperative management under fast-track model from January to December 2014. The reasons for discharging over 72 hours after hospitalization were analyzed. Results Among the 152 patients, 119 were discharged over 72 hours after surgery, and the rate was 78.2%. The main reasons for delayed discharge were pain (32.8%), limited range of motion (31.9%) and unwillingness to be discharged (27.7%), respectively. Conclusion For patients who have undergone TKA, FT model can shorten hospital stay, save expenses, and accelerate postoperative rehabilitation, but there is still much room for improvement.

Citation： TuXiaoqing, NingNing, ChenZhonglan, HouXiaoling, ChenJiali. Reasons for Delayed Discharge after Total Knee Arthroplasty under Fast-track Recovery Model. West China Medical Journal, 2016, 31(4): 739-742. doi: 10.7507/1002-0179.201600201 Copy

1.	Wilmore DW, Kehlet H. Recent advances - management of patients in fast track surgery[J]. Br Med J, 2001, 322(7284): 473-476.
2.	Husted H, Jensen CM, Solgaard S, et al. Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009: from research to implementation[J]. Arch Orthop Trauma Surg, 2012, 132(1): 101-104.
3.	付丽敏, 杨小华, 吕永明, 等. 加速康复外科在全膝置换患者康复治疗中的应用[J]. 中国组织工程研究与临床康复, 2011, 15(22): 4019-4022.
4.	刘恒旸, 乔继红, 王华锋, 等. 快速康复外科理念在全膝关节置换围手术期管理中的应用[J]. 齐齐哈尔医学院学报, 2011, 32(20): 3374-3376.
5.	Hansen TB, Bredtoft HK, Larsen K. Preoperative physical optimization in fast-track hip and knee arthroplasty[J]. Dan Med J, 2012, 59(2): A4381.
6.	Kjaersgaard-Andersen P, Kehlet H. Should deep venous thrombosis prophylaxis be used in fast-track hip and knee replacement?[J]. Acta Orthop, 2012, 83(2): 105-106.
7.	Husted H, Troelsen A, Otte KS, et al. Fast-track surgery for bilateral total knee replacement[J]. J Bone Joint Surg Br, 2011, 93(3): 351-356.
8.	Husted H, Solgaard S, Hansen TB, et al. Care principles at four fast-track arthroplasty departments in Denmark[J]. Dan Med Bull, 2010, 57(7): A4166.
9.	Jorgensen CC, Kehlet H, Lundbeck Fdn Ctr Fast-Track Hip and Knee Replacement Collaborative Grp. Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty[J]. Acta Anaesthesiol Scand, 2013, 57(5): 631-638.
10.	Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty[J]. Br J Anaesth, 2012, 109(5): 769-775.
11.	Husted H, Otte KS, Kristensen BB, et al. Readmissions after fast-track hip and knee arthroplasty[J]. Arch Orthop Trauma Surg, 2010, 130(9): 1185-1191.
12.	Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark[J]. Arch Orthop Trauma Surg, 2010, 130(2): 263-268.
13.	Husted H, Holm G. Fast track in total hip and knee arthroplasty - experiences from Hvidovre University Hospital, Denmark[J]. Injury, 2006, 37(5): S31-S35.
14.	Munk S, Dalsgaard J, Bjerggaard K, et al. Early recovery after fast-track Oxford unicompartmental knee arthroplasty. 35 patients with minimal invasive surgery[J]. Acta Orthop, 2012, 83(1): 41-45.
15.	Husted H, Lunn TH, Troelsen A, et al. Why still in hospital after fast-track hip and knee arthroplasty?[J]. Acta Orthop, 2011, 82(6): 679-684.
16.	Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients[J]. Acta Orthop, 2008, 79(2): 168-173.
17.	Lavernia CJ, Sierra RJ, Baerga L. Nutritional parameters and short term outcome in arthroplasty[J]. J Am Coll Nutr, 1999, 18(3): 274-278.
18.	Husted H, Otte KS, Kristensen BB. Fast-track revision knee arthroplasty. A feasibility study[J]. Acta Orthop, 2011, 82(4): 438-440.

1. Wilmore DW, Kehlet H. Recent advances - management of patients in fast track surgery[J]. Br Med J, 2001, 322(7284): 473-476.
2. Husted H, Jensen CM, Solgaard S, et al. Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009: from research to implementation[J]. Arch Orthop Trauma Surg, 2012, 132(1): 101-104.
3. 付丽敏, 杨小华, 吕永明, 等. 加速康复外科在全膝置换患者康复治疗中的应用[J]. 中国组织工程研究与临床康复, 2011, 15(22): 4019-4022.
4. 刘恒旸, 乔继红, 王华锋, 等. 快速康复外科理念在全膝关节置换围手术期管理中的应用[J]. 齐齐哈尔医学院学报, 2011, 32(20): 3374-3376.
5. Hansen TB, Bredtoft HK, Larsen K. Preoperative physical optimization in fast-track hip and knee arthroplasty[J]. Dan Med J, 2012, 59(2): A4381.
6. Kjaersgaard-Andersen P, Kehlet H. Should deep venous thrombosis prophylaxis be used in fast-track hip and knee replacement?[J]. Acta Orthop, 2012, 83(2): 105-106.
7. Husted H, Troelsen A, Otte KS, et al. Fast-track surgery for bilateral total knee replacement[J]. J Bone Joint Surg Br, 2011, 93(3): 351-356.
8. Husted H, Solgaard S, Hansen TB, et al. Care principles at four fast-track arthroplasty departments in Denmark[J]. Dan Med Bull, 2010, 57(7): A4166.
9. Jorgensen CC, Kehlet H, Lundbeck Fdn Ctr Fast-Track Hip and Knee Replacement Collaborative Grp. Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty[J]. Acta Anaesthesiol Scand, 2013, 57(5): 631-638.
10. Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty[J]. Br J Anaesth, 2012, 109(5): 769-775.
11. Husted H, Otte KS, Kristensen BB, et al. Readmissions after fast-track hip and knee arthroplasty[J]. Arch Orthop Trauma Surg, 2010, 130(9): 1185-1191.
12. Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark[J]. Arch Orthop Trauma Surg, 2010, 130(2): 263-268.
13. Husted H, Holm G. Fast track in total hip and knee arthroplasty - experiences from Hvidovre University Hospital, Denmark[J]. Injury, 2006, 37(5): S31-S35.
14. Munk S, Dalsgaard J, Bjerggaard K, et al. Early recovery after fast-track Oxford unicompartmental knee arthroplasty. 35 patients with minimal invasive surgery[J]. Acta Orthop, 2012, 83(1): 41-45.
15. Husted H, Lunn TH, Troelsen A, et al. Why still in hospital after fast-track hip and knee arthroplasty?[J]. Acta Orthop, 2011, 82(6): 679-684.
16. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients[J]. Acta Orthop, 2008, 79(2): 168-173.
17. Lavernia CJ, Sierra RJ, Baerga L. Nutritional parameters and short term outcome in arthroplasty[J]. J Am Coll Nutr, 1999, 18(3): 274-278.
18. Husted H, Otte KS, Kristensen BB. Fast-track revision knee arthroplasty. A feasibility study[J]. Acta Orthop, 2011, 82(4): 438-440.

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Reasons for Delayed Discharge after Total Knee Arthroplasty under Fast-track Recovery Model

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