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TJA soon likely to offer same-day discharge
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In most Scandinavian orthopaedic clinics, the length of stay after total joint arthroplasty has been reduced significantly in the last decade. At my institution, Vejle Hospital, in Vejle, Denmark, the length of stay after these procedures has decreased from about 10 days in 2001 to an average of 2.3 days in 2014. This includes all types of primary and revision cases, acute neck fractures treated with total hip arthroplasty, and surgery in old and young patients. The only exceptions are revisions done for deep infection.
The main reason such a dramatic reduction in length of stay (LOS) was possible is the introduction of a rapid recovery program led by a multidisciplinary team. The focus for our team has been on what is needed to further reduce the LOS. Key considerations are drugs for multimodal pain management, detailed preoperative information provided to the patients and hospital staff, and early mobilization.
As an outgrowth of the success we have had with this new approach to total hip arthroplasty (THA) and total knee arthroplasty (TKA), the question has been raised as to what is needed to change the LOS so discharge is possible on the day of surgery for THA and TKA patients. During the past few years, younger patients have requested the opportunity to leave the clinic on the day of surgery. We planned those cases to be done first in the morning, to have the patient mobilized before lunchtime, and then fully mobilized by the early evening, so the patient left the clinic about 6:00 pm. However, to date we have not devised a detailed set-up to handle many more such cases.
Click here to read the full Commentary in the July/August issue of Orthopaedics Today Europe.