• Pelle Baggesgaard Petersen, Christoffer Calov Jørgensen, Henrik Kehlet, and Lundbeck Foundation Center for Fast-track Hip and Knee Replacement collaborative group.
• Pelle.Petersen.01@regionh.dk.
• Dan Med J. 2019 Jul 1; 66 (7).

IntroductionImplementation of fast-track protocols in total hip and knee arthroplasty (THA/TKA) has dramatically changed the perioperative care, leading to a subsequent reduction in post-operative length of stay (LOS) and mor-bidity. Previous investigations in Denmark have shown a reduction in LOS from about ten days in 2000 to four days in 2009. We aimed to describe temporal changes in LOS and readmissions within the context of a continuous multicentre collaboration focusing on enhancing recovery and reducing morbidity after fast-track THA and TKA.MethodsWe used an observational cohort design from nine Danish orthopaedic centres. All procedures were performed from January 2010 to August 2017. Data on LOS and 90-day readmissions were obtained from The Danish National Patient Registry. Cause of readmission and possible association with surgery were investigated using discharge summaries or health records.ResultsWe included 36,608 procedures with a median age of 69 (range: 62-75) years of whom 58% were women. LOS decreased from a median of three (range: 2-3) days in 2010 to one (range: 1-2) days in 2017. The proportion of patients with LOS > 4 days decreased from 9.6% to 4.4%. Still, 90-day readmissions remained stable throughout the period at ≈ 8%.ConclusionsA reduction in both LOS and proportion of patients with prolonged LOS without an increase in readmission is possible within a multicentre collaboration aiming at enhancing recovery and reducing morbidity.FundingThe study was supported by an unconditional PhD grant from Lundbeckfonden to PBP (R230-2017-166).Trial RegistrationThe study was registered with ClinicalTrials.gov (NCT01515670).Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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