Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures

Figures & data

Table 1. The different stages of the rapid recovery protocol. Group 1 represents the patients who were operated in the period before the protocol was introduced. Group 2 represents the patients who were operated during the period in which the rapid recovery protocol was introduced in several stages. Group 3 represents the patients who were operated after all the stages of the rapid recovery protocol had been introduced

• Preoperative education

• Local infiltration anesthesia

• Standardized protocol for pain medication

• Opioid medication only on request (rescue medication)

• No compression bandages

• No drains

• No standard urine catheters

• Start rehabilitation and mobilization on day of surgery

• Checking the fulfillment of discharge criteria twice a day

• Optimization of the aftercare

Table 2. Demographics. For an explanation of the 3 groups, see Table 1

	Group 1	Group 2	Group 3	p-value
Age (years)	71	71	71	0.2
SD	10	9	10
Gender, % female	68	69	69	1.0
BMI, kg/m²	26.7	27.1	26.9	0.3
SD	4.3	4.3	4.2
ASA classification
I	22	20	20	0.9
II	66	66	66
III	13	14	14
IV	–	–	0.3
Anesthesia, % spinal	91	87	90	0.06
Priority, % elective	99	99	98	0.3
Diagnosis, % primary	93	88	88	0.2
Direction of discharge, %
home	82	82	80	0.7
TNH ^a	19	18	19
AD ^b	–	0.2	0.8
Approach, %
ASI	27	45	52	< 0.001
SL	73	49	45
PL	–	6	4
Side, % right	56	55	55	1.0

^a TNH: temporary nursing home for further rehabilitation.

^b AD: another department of our hospital for treatment for non-orthopedic pathology.

Table 3. Length of hospital stay, complications, re-admissions, and reoperations after primary THA

	Group 1	Group 2	Group 3	p-value
Length of hospital stay, days
Mean	4.6	3.7	2.9	< 0.001
SD	1.2	1.3	1.4	< 0.001
Median	4	3	3	< 0.001
Complications, %	7.6	7.0	7.8	0.9
Re-admissions in < 3 months, %	4.5	3.4	4.4	0.7
Reoperations, %	7.0	4.4	3.9	0.3
Reoperations in < 3 months, %	3.8	2.3	2.9	0.5

Percentage nights in hospital after primary THA for the 3 groups.

Table 4. Reasons for re-admission within the first 3 months after primary THA

	Group 1n = 157	Group 2n = 639	Group 3n = 384
Infection	5 (3.2%)	6 (0.9%)	7 (1.8%)
Dislocation	2 (1.3%)	9 (1.4%)	3 (0.8%)
Fracture	–	2 (0.3%)	–
Wound problems	–	5 (0.8%)	2 (0.5%)
Malposition of prosthesis	–	–	1 (0.3%)
Anemia	–	–	3 (0.8%)
Pain, unknown cause	–	–	1 (0.3%)
Total	7 (4.5%)	22 (3.4%)	17 (4.4%)