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, 467 (6), 1412-7

THA With a Minimally Invasive Technique, Multi-Modal Anesthesia, and Home Rehabilitation: Factors Associated With Early Discharge?

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THA With a Minimally Invasive Technique, Multi-Modal Anesthesia, and Home Rehabilitation: Factors Associated With Early Discharge?

Dana Christopher Mears et al. Clin Orthop Relat Res.

Erratum in

  • Clin Orthop Relat Res. 2009 Jul;467(7):1928

Abstract

Multimodal anesthetic and pain regimens with minimally invasive surgical approaches and rapid rehabilitation protocols are thought to decrease length of stay after hip replacement. We asked whether a program including these three elements could achieve 23-hour discharge in a group of 665 patients and whether the length of hospital stay was influenced by patient age, gender, body mass index, change in hemoglobin or estimated blood loss, duration of surgery (< or = 90 or > 90 minutes), or American Society of Anesthesiologists physical status classification. Of the 665 patients, 259 (38.9%) were discharged home with indwelling peripheral nerve catheters. Hospital discharge in less than 24 hours was achieved in 295 (44.4%) of the 665 patients. After discharge, 73.5% of patients required no home or outpatient nursing care or physical therapy. Eighteen (2.7%) dislocations, eight (1.2%) femoral fractures requiring surgery, and thirteen (2.0%) revision procedures occurred within 90 days. Female gender, increasing age, increasing estimated blood loss, and American Association of Anesthesiologists classification 3 or 4 increased length of stay. Additional study is needed to confirm these factors and develop prospective prediction rules to allow for an outpatient approach to joint arthroplasty.

Level of evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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