Wilches C, Sulbarán J D, Fernández J E, Gisbert J M, Bausili J M, Pelfort X
Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
Rev Esp Cir Ortop Traumatol. 2017 Mar-Apr;61(2):111-116. doi: 10.1016/j.recot.2016.10.002. Epub 2017 Jan 8.
To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates.
Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups.
Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months.
There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates.
确定在初次全髋关节置换术（THR）和全膝关节置换术（TKR）中，与传统康复方法相比，采用强化康复路径（快速康复）时的成本降低情况和并发症发生率，并确定并发症发生率是否存在显著差异。
回顾性分析100例采用快速康复系统的初次全关节置换术病例以及另外100例采用传统康复方法的病例。测量患者的性别、Charlson合并症指数、美国麻醉医师协会（ASA）评分、住院时间和早期并发症，以及院内并发症、术后前六个月的并发症、再入院率和输血率。确定住院总费用和每日费用，并根据两组间住院时间的缩短情况计算成本降低幅度。
两组在年龄、性别、ASA评分和Charlson指数方面具有可比性。TKR组平均住院时间缩短4.5天，THR组缩短2.1天。计算得出TKR组成本降低1266欧元，THR组降低583欧元。两组在院内并发症、输血需求、再入院率以及术后前六个月的并发症发生率方面无统计学显著差异。
在所查阅的文献中，很少有分析在关节置换术中采用快速康复方案对成本影响的出版物。几个比较康复方案的已发表系列研究也发现并发症发生率无显著差异。采用快速康复方案使TKR组成本显著降低1266欧元，THR组降低583欧元，且不影响并发症发生率。
