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What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark

  • Orthopaedic Outcome Assessment
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The goal of this study was (1) to identify logistical and clinical areas of importance for length of stay (LOS) by identifying departments with short and long LOS and to evaluate their set-up; and (2) to evaluate patient satisfaction in relation to LOS.

Materials and methods

Based on the National Register on Patients in 2004 on LOS following total hip and knee arthroplasty (THA and TKA), departments with short and long LOS were identified. The three departments with the shortest and the three departments with the longest postoperative hospital stay were chosen for evaluation. The logistic setup and the clinical treatment/pathway were examined with on-location focus interviews to identify logistic and clinical factors acting as improvement or barriers for early rehabilitation and subsequent discharge. Also, the patients from these departments answered a questionnaire regarding satisfaction with components of their stay, co-morbidity, sex and age.

Results

Mean LOS was 7.4 and 8.0 days after THA and TKA, respectively staying from 4.5 to 12 days. Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up to date information including expectations on a short stay, functional discharge criteria) and clinical features (multimodal opioid-sparing analgesia, early mobilisation and discharge when criteria were met) facilitating quick rehabilitation and discharge. Patient demographics from departments with the shortest stay were similar co-morbidities than patients from departments with longer stays, but were either as satisfied—or more satisfied—with all parts of their stay. There was no difference in staffing (nurses/physiotherapists) between the two types of departments.

Conclusion

Nationwide implementation of fast-track THA and TKA would result in a significant decrease in the needed number of hospital beds with similar or better outcome for the patients. Implementation of updated logistical and clinical features is expected to increase rehabilitation and reduce LOS with similar or improved patient satisfaction. These results support the implementation of fast-track total hip- and knee arthroplasty.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Hvidovre Hospital, 2650, Hvidovre, Denmark

    Henrik Husted & Gitte Holm

  2. Health Care Consulting, 1620, Copenhagen, Denmark

    Hans Christian Hansen & Charlotte Bach-Dal

  3. Unit for Perioperative Nursing, Juliane Marie Centre, Rigshospitalet, 2100, Copenhagen, Denmark

    Kirsten Rud

  4. Center for Evaluation of Medical Technology, CEMTV, National Board of Health, Copenhagen, Denmark

    Kristoffer Lande Andersen

  5. Section for Surgical Pathophysiology 4074, Juliane Marie Centre, Rigshospitalet, 2100, Copenhagen, Denmark

    Henrik Kehlet

Authors
  1. Henrik Husted
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  2. Hans Christian Hansen
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  3. Gitte Holm
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  4. Charlotte Bach-Dal
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  5. Kirsten Rud
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  6. Kristoffer Lande Andersen
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  7. Henrik Kehlet
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Corresponding author

Correspondence to Henrik Husted.

Additional information

This study is part of a larger nationwide survey initiated by CEMTV, National Board of Health (http://www.SST.dk) and is based on three studies published in Ugeskrift Laeger 2006.

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Husted, H., Hansen, H.C., Holm, G. et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130, 263–268 (2010). https://doi.org/10.1007/s00402-009-0940-7

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  • DOI: https://doi.org/10.1007/s00402-009-0940-7

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