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Study time period has greater impact than type of hip procedure on perioperative results
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When total hip arthroplasty was compared with surface replacement arthroplasty, researchers found the study period had a greater impact on time to hospital discharge than the type of surgical procedure.
“If we are trying to institute new [surgical] techniques, then we should be comparing them in a prospective fashion rather than comparing them to what we used to do historically,” Denis Nam, MD, MSc, told Orthopedics Today. “We attribute a lot of our [results], for example, the rate of discharge, to what we are doing based on a specific surgical technique. But, it may be because there are other perioperative factors, whether it is patient education or simply changes in perioperative protocols that may be causing more of a drastic change than the surgical technique itself.”
Nam and his colleagues matched and compared 100 total hip arthroplasty (THA) and 100 surface replacement arthroplasty patients who had procedures performed between 2004 and 2010 with 50 THA and 50 surface replacement patients who had procedures performed between 2010 and 2012. Patients who underwent surgery between 2004 and 2010 were placed in the historical period group, while those who underwent surgery between 2010 and 2012 were in the recent period group.
The researchers found significant improvements in time to discharge and hospital utilization, with an approximate 16-hour difference in time to discharge between recent and historical THA groups, as well as between recent and historical surface replacement groups. However, researchers noted VAS pain scores were increased at discharge in the recent THA cohort, while VAS pain scores at discharge and morphine equivalents used per day were increased in the recent surface replacement cohort.
Patients who underwent THA in the historical and recent time periods were discharged approximately 9 hours earlier compared with patients who underwent surface replacement. According to study results, although rates of spinal anesthesia utilization between THA and surface replacement cohorts in both the historical and recent time periods were similar, operative time was significantly less for patients who underwent THA vs. surface replacement. Nam and his colleagues found patients who underwent THA in both the historical and recent cohorts had a decreased length of stay vs. patients who underwent surface replacement. However, patients in the recent surface replacement cohort were discharged sooner vs. patients in the historical THA group.
“It is hard to say that, in this example, doing a more minimally invasive approach (during THA) had a greater impact on an earlier discharge; but what was more impactful was we were comparing two different time periods,” Nam said. “There are a number of different factors that could change during those time periods that would have more of an impact in this example on the rate of discharge.” – by Casey Tingle
- Reference:
- Nam D, et al. J Arthroplasty. 2015;doi:10.1016/j.arth.2015.02.002.
- For more information:
- Denis Nam, MD, MSc, can be reached at Washington University Orthopedics, Barnes Jewish Hospital, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110; email: namd@wudosis.wustl.edu.
Disclosure: Nam reports no relevant financial disclosures.