Yang Guojing, Chen Wanchen, Chen Wenliang, Tang Xiaojun, Huang Yijiang, Zhang Lei
Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
J Arthroplasty. 2016 Aug;31(8):1686-1692.e1. doi: 10.1016/j.arth.2016.02.011. Epub 2016 Feb 17.
A fast-track program (FT) can shorten hospital stay after total hip arthroplasty. The aim of this prospective randomized study was to investigate the feasibility and safety of 2-day discharge after fast-track total hip arthroplasty in a Chinese population.
A total of 258 selected patients who underwent unilateral primary total hip arthroplasty were enrolled into the final cohort and were randomized into the FT (n = 126) and standard program group (n = 132). In the FT group, the patients received a multidisciplinary FT, whereas the patients in the standard program group only followed a standard care program. After setting restricted discharge criteria, we undertook follow-up evaluations to investigate the length of hospital stay, clinical performance, 30-day and 90-day complications, and 90-day admissions in both groups. A multivariate regression model was used to assess independent predictors of delayed discharge (>2 days).
The mean length of stay was reduced from 5.8 to 2.1 days after implementation of our FT (P < .001). Most patients in the FT group (82.5%) were discharged within 2 days postoperatively. However, the complications and readmissions appeared no difference between the two groups. The multivariate regression analysis identified age (P = .041), operative time (P < .001), intraoperative blood loss (P = .026), and total blood loss (P < .001) as the predictive factors for delayed discharge.
A 2-day discharge protocol after fast-track total hip arthroplasty can be safe and feasible in selected patients, without increasing the risk of complications and readmissions. Further efforts are needed to shorten operative time and reduce perioperative blood loss and eventually to shorten hospital stay.
快速康复计划（FT）可缩短全髋关节置换术后的住院时间。本前瞻性随机研究旨在探讨在中国人群中，快速康复全髋关节置换术后2天出院的可行性和安全性。
总共258例接受单侧初次全髋关节置换术的入选患者被纳入最终队列，并随机分为快速康复组（n = 126）和标准治疗组（n = 132）。在快速康复组中，患者接受多学科快速康复治疗，而标准治疗组的患者仅遵循标准护理方案。设定出院限制标准后，我们进行随访评估，以调查两组患者的住院时间、临床表现、30天和90天并发症以及90天再入院情况。采用多变量回归模型评估延迟出院（>2天）的独立预测因素。
实施快速康复计划后，平均住院时间从5.8天缩短至2.1天（P < .001）。快速康复组中的大多数患者（82.5%）在术后2天内出院。然而，两组之间的并发症和再入院情况并无差异。多变量回归分析确定年龄（P = .041）、手术时间（P < .001）、术中失血（P = .026）和总失血量（P < .001）为延迟出院的预测因素。
对于选定的患者，快速康复全髋关节置换术后2天出院方案可能是安全可行的，且不会增加并发症和再入院的风险。需要进一步努力缩短手术时间、减少围手术期失血，最终缩短住院时间。
