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· DOS Abstracts
Risk of readmission, reoperation and mortality within
90 days of total hip and knee arthroplasty in fast-
track departments in Denmark from 2005 to 2011
Eva Natalia Glassou, Alma Becic Pedersen, Torben Bæk Hansen
Department of Orthopedic Surgery, Regional Hospital West Jutland, Denmark;
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
Background:
Fast track programs are widely adopted in the treatment of hip
and knee arthroplasties. Several clinical studies have shown that fast track pro-
grams reduce adverse events. This study evaluates fast track programs in a
population based cohort.
Purpose / Aim of Study:
The aim was to compare risk of readmission, reop-
eration and mortality within 90 days of surgery in orthopedic departments with
well documented fast track arthroplasty programs with all other orthopedic de-
partments in Denmark from 2005 to 2011.
Materials and Methods:
The Danish Hip and Knee Arthroplasty Registers
were used to identify patients with primary total hip and knee arthroplasty.
Information about readmission, reoperation and mortality was obtained from
national databases. The fast track cohort consisted of departments participating
in the Lundbeck Foundation Centre for Fast- track Hip and Knee Replacement.
The national cohort consisted of all other departments. Cohorts were divided
into 3 periods; 2005-2007, 2008-2009 and 2010-2011. Regression meth-
ods were used to calculate relative risk (RR) for adverse events adjusting for
age, sex, type of fixation and co- morbidity.
Findings / Results:
79,098 arthroplasties were included; 17,284 in the fast
track cohort and 61,814 in the national cohort. Median length of stay (LOS)
was less for the fast track cohort in all 3 periods (4/3/3 vs. 6/4/3 days). RR of
readmission due to infection was higher in the fast track cohort in 2005-2007
(1.3, 95% CI 1.1-1.6). RR of readmission due to thrombo-embolic event was
lower in the fast track cohort in 2010-2011 (0.7, CI 0.6-0.9).
Conclusions:
The general reduction in LOS indicates that fast track programs
are widely implemented. Concurrently it seems that dedicated fast track de-
partments are able to optimize the fast track program further without a rise in
readmission, reoperation and mortality.
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