Fast Track THR: One Hospital’s Experience with a 2-Day Length of Stay Protocol for Total Hip ReplacementReport as inadecuate

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HSS Journal

, 7:223

First Online: 02 July 2011Received: 05 January 2011Accepted: 25 April 2011


BackgroundCurrent trends in total joint replacement have focused on shorter hospital stays.

PurposeThis study aimed to determine if a pathway for total hip replacement THR with the goal of a 2-day discharge fast track is safe and effective compared to our traditional pathway control.

MethodsOne hundred forty-nine patients undergoing unilateral, uncomplicated, THR were enrolled in an accelerated postoperative pathway and 134 were enrolled in the traditional pathway. Patients were followed prospectively and outcomes included hospital length of stay, intra- and postoperative complications, readmissions, reoperations. A statistical model was created to determine factors predictive of a 2-day discharge.

ResultsAt 1 year, there were no differences in complications, readmissions, or reoperations. The average length of stay decreased from 4.1 to 2.6 days p < 0.0001. In the fast track group, 58% of patients were discharged home within 2 days. Barriers to a 2-day discharge were postoperative pain, nausea, and dizziness. The only preoperative factor that was predictive of a 2-day discharge was hypertension.

ConclusionsIn a select group of patients, a protocol that allows for a 2-day discharge following THR is safe and effective.

Keywordstotal hip replacement postoperative protocol accelerated discharge clinical pathway Each author certifies that he or she has no commercial associations e.g., consultancies, stock ownership, equity interest, patent-licensing arrangements, etc. that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was approved by the Institutional Review Board at the Hospital for Special Surgery. Investigation performed at the Hospital for Special Surgery.

Level of Evidence: Level II: Prospective Cohort Study

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Author: Lawrence V. Gulotta - Douglas E. Padgett - Thomas P. Sculco - Michael Urban - Stephen Lyman - Bryan J. Nestor


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