Article

Multimodal techniques can aid early rehabilitation and
discharge of patients following primary joint replacement. We hypothesized that
this not only reduces the economic burden of joint replacement by reducing length
of stay, but also helps in reduction of early complications.
METHODS: We evaluated 4,500 consecutive unselected total hip replacements and
total knee replacements regarding length of hospital stay, mortality, and
perioperative complications. The first 3,000 underwent a traditional protocol
while the other 1,500 underwent an enhanced recovery protocol involving
behavioral, pharmacological, and procedural modifications. RESULTS: There was a
reduction in 30-day death rate (0.5% to 0.1%, p = 0.02) and 90-day death rate
(0.8% to 0.2%, p = 0.01). The median length of stay decreased from 6 days to 3
days (p < 0.001), resulting in a saving of 5,418 bed days. Requirement for blood
transfusion was reduced (23% to 9.8%, p < 0.001). There was a trend of a reduced
rate of 30-day myocardial infarction (0.8% to 0.5%. p = 0 .2) and stroke (0.5% to
0.2%, p = 0.2). The 60-day deep vein thrombosis figures (0.8% to 0.6%, p = 0.5)
and pulmonary embolism figures (1.2% to 1.1%, p = 0.9) were similar. Re-admission
rate remained unchanged during the period of the study (4.7% to 4.8%, p = 0.8).
INTERPRETATION: This large observational study of unselected consecutive hip and
knee arthroplasty patients shows a substantial reduction in death rate, reduced
length of stay, and reduced transfusion requirements after the introduction of a
multimodal enhanced recovery protocol.

Langue : ANGLAIS