Patients who undergo total hip replacement and are considered generally
healthy can be fast tracked to be discharged within 2 days instead of the
standard 3 days to 6 days, according to researchers at Hospital for Special
The study and its findings were published online in the HSS
“Before this study, we were uncertain how safe it would be to
discharge patients within 2 days after a total hip replacement (THR), but based
on this study, we now know that it’s safe,” first author Lawrence
Gulotta, MD, stated in a Hospital for Special Surgery press release.
The study compared the outcomes of two cohorts of patients undergoing
THR at Hospital for Special Surgery between 2004 and 2008. One 149-patient
cohort underwent THR with a fast track protocol, while a 134-patient cohort
underwent THR followed by the hospital’s traditional clinical pathway
– a 4-day wait until discharge.
Patients were excluded from the study if they reported inflammatory
arthritis, has a complex THR or medical comorbidities, such as a history of
myocardial infarction, pulmonary embolism or deep vein thrombosis.
Patients undergoing the fast track protocol were given a physical
therapy session on the day of their surgery. The main difference between the
two protocols, the study noted, was the fast track cohort’s
discontinuation of pain medication on postoperative day one as opposed to the
traditional cohort’s 2-day discontinuation.
Bryan J. Nestor
Both cohorts were sent home with aspirin, physical therapy arrangements,
a patient management plan including daily goals, and control plans for pain and
nausea. A study coordinator screened for complications 1 day and 1 week after
Fifty-eight percent of the fast track cohort was discharged within 2
days of a THR, with 73% of patients discharged within 3 days. Fast track
patients were discharged at an average of 2.6 days, while the traditional
cohort discharged in an average of 4.1 days.
At 1 year, there were no differences between the cohorts for
complications, re-admissions or reoperations.
“For a select group of patients, we have shown that a 2-day
discharge is safe and feasible for patients undergoing a total hip
replacement,” principal investigator Bryan Nestor, MD, stated in the
- Gulotta LV, Padgett DE, Sculco TP, et al. Fast track THR: One
hospital’s experience with a 2-day length of stay protocol for total hip
replacement. HSS J. 2011. doi: 10.1007/s11420-011-9207-2.
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