Lyndrup Oliver, Kehlet Henrik, Jørgensen Christoffer C, Lindberg-Larsen Martin, Jakobsen Thomas, Gromov Kirill, Andersen Mikkel R, Bieder Manuel, Overgaard Søren, Varnum Claus
Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark; Department of Orthopaedic Surgery, Lillebaelt Hospital - Vejle, Vejle, Denmark.
Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen, Denmark; Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
J Arthroplasty. 2025 Jul;40(7):1690-1695. doi: 10.1016/j.arth.2024.12.005. Epub 2024 Dec 7.
Following the implementation of the fast-track protocol in total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA), the median length of stay (LOS) has been significantly reduced without an increase in readmissions. However, it is unclear if the reduction in LOS is at the expense of an increase in nonhome discharge. The aim of this study was to investigate the discharge destination among THA, TKA, and UKA patients.
The prospective multicenter study included 6,856 patients undergoing primary THA, TKA, and UKA in a fast-track setting with an overall median LOS of one day. Outcomes were discharge destination, median LOS in each discharge destination category, and cause of rehabilitation center discharge. Data were gathered using preoperative questionnaires and a review of medical records. Discharge destination and LOS were registered at discharge.
We found that 99% of patients had been discharged to their own homes, of which 21% had been discharged to their own homes with home care. There were 1% who were discharged to a rehabilitation facility and 0.1% who were discharged to a nursing home. The THA (1%, 95% confidence interval [CI] 0.7 to 1) and TKA (1%, 95% CI 0.9 to 2) had a significantly higher rate of discharge to a rehabilitation facility compared to UKA (0.1%, 95% CI 0.0 to 0.5).
Despite a short LOS, 99% of patients were discharged to their own homes. Rehabilitation facility discharge was only 1% and was mostly caused by inadequate postoperative mobilization.
在全髋关节置换术（THA）、全膝关节置换术（TKA）和单髁膝关节置换术（UKA）中实施快速康复方案后，中位住院时间（LOS）显著缩短，且再入院率并未增加。然而，尚不清楚住院时间的缩短是否是以非家庭出院率的增加为代价。本研究的目的是调查THA、TKA和UKA患者的出院去向。
这项前瞻性多中心研究纳入了6856例在快速康复模式下接受初次THA、TKA和UKA的患者，总体中位住院时间为1天。观察指标为出院去向、各出院去向类别的中位住院时间以及康复中心出院原因。通过术前问卷和病历审查收集数据。出院时记录出院去向和住院时间。
我们发现99%的患者已出院回家，其中21%是在有家庭护理的情况下出院回家。1%的患者出院至康复机构，0.1%的患者出院至养老院。与UKA（0.1%，95%置信区间[CI]0.0至0.5）相比，THA（1%，95%CI 0.7至1）和TKA（1%，95%CI 0.9至2）出院至康复机构的比例显著更高。
尽管住院时间较短，但99%的患者出院回家。康复机构出院率仅为1%，主要原因是术后活动不足。
