Holm Bente, Bandholm Thomas, Lunn Troels Haxholdt, Husted Henrik, Aalund Peter Kloster, Hansen Torben Bæk, Kehlet Henrik
The Lundbeck Center for Fast-track Hip- and Knee Arthroplasty.
Acta Orthop. 2014 Sep;85(5):488-92. doi: 10.3109/17453674.2014.934186. Epub 2014 Jun 23.
The concept of fast-track surgery has led to a decline in length of stay after total hip arthroplasty (THA) and total knee arthroplasty (TKA) to about 2-4 days. However, it has been questioned whether this is only achievable in selected patients-or in all patients. We therefore investigated the role of preoperative pain and functional characteristics in discharge readiness and actual LOS in fast-track THA and TKA.
Before surgery, hip pain (THA) or knee pain (TKA), lower-extremity muscle power, functional performance, and physical activity were assessed in a sample of 153 [corrected] patients and used as independent variables to predict the outcome (dependent variable) – readiness for hospital discharge – for each type of surgery. Discharge readiness was assessed twice daily by blinded assessors
Median discharge readiness and actual length of stay until discharge were both 2 days. Univariate linear regression followed by multiple linear regression revealed that age was the only independent predictor of discharge readiness in THA and TKA, but the standardized coefficients were small (≤ 0.03).
These results support the idea that fast-track THA and TKA with a length of stay of about 2-4 days can be achieved for most patients independently of preoperative functional characteristics.
快速康复外科理念已使全髋关节置换术（THA）和全膝关节置换术（TKA）后的住院时间缩短至约2 - 4天。然而，有人质疑这是否仅在特定患者中可行——还是在所有患者中都可行。因此，我们研究了术前疼痛和功能特征在快速康复THA和TKA患者出院准备情况及实际住院时间方面的作用。
术前，对153例[校正后]患者样本进行髋关节疼痛（THA）或膝关节疼痛（TKA）、下肢肌肉力量、功能表现及身体活动评估，并将其作为自变量来预测每种手术类型的结果（因变量）——出院准备情况。由不知情的评估者每天两次评估出院准备情况。
出院准备情况的中位数和实际出院前住院时间均为2天。单变量线性回归后进行多变量线性回归显示，年龄是THA和TKA出院准备情况的唯一独立预测因素，但标准化系数较小（≤0.03）。
这些结果支持这样一种观点，即对于大多数患者而言，无论术前功能特征如何，均可实现住院时间约为2 - 4天的快速康复THA和TKA。
