DOS 2019

DOS Kongressen 2019 · 163 Improvements in postoperative outcome after fast-track hip and knee arthroplasty in the elderly – a prospective multicenter cohort study of 1427 procedures in patients ≥ 85 years Pelle Baggesgaard Petersen, Christoffer Calov Jørgensen, Henrik Kehlet Section for Surgical Pathophysiology, Rigshospitalet Background: Fast-track protocols in total hip and knee arthroplasty (THA/ TKA) have improved postoperative recovery and reduced postoperative mor- bidity. Additionally, increasing life expectancy and improved surgical techniques have led to an increasing number of elderly patients undergoing THA and TKA. However, detailed studies on fast- track THA and TKA in the elderly are limited. Purpose / Aim of Study: To describe length of stay (LOS) and postoperative morbidity in patients ≥ 85 years within a continuous multicenter fast-track col- laboration. Materials and Methods: We used a prospective observational cohort design with unselected consecutive data between 2010– 2017 on primary elective THA and TKA patients ≥ 85 years. Data were obtained from 9 centers reporting to the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement database (www.FTHK.dk ) and the Danish National Patient Registry on LOS, re- admissions, and mortality. Cause of morbidity were determined by review of health records. Findings / Results: We included 1427 (3.9% of all THA/TKA) procedures with 62.3% THA. Median age was 87 (IQR: 85-88) years with 71% women. LOS de- creased from median 4 (3-6) days in 2010 to 2 (2- 3) days in 2017. The pro- portion with LOS > 4 days decreased from 32 % to 18%, with a decrease in both combined “surgical”, “medical”, and no recorded morbidity leading to LOS > 4 days. No single specific organ dysfunction dominated the overall improvement. Readmission and mortality rates remained at about 11.7% and 0.9% at 30 days and 18.0% and 1.5% at 90 days, respectively. However, with a tendency to- wards a slight increase in “surgical” morbidity leading to readmissions ≤ 90 days. Conclusions: This, detailed large multicenter fast-track THA/TKA study in pa- tients ≥ 85 years found major improvements in LOS and patients with LOS > 4 days without increase in readmission or mortality rates. The unchanged read- mission rate poses an area for further improvements. 119.