Postop morbidity, discharge in elderly fast-track total joint patients

Editor's Note

Fast-track total hip and knee arthroplasties with a median length of stay of 3 days and discharge to home are feasible in most patients 85 years of age or older, this study finds.

Of 13,775 procedures included in the analysis:

• median age was 87 years and median length of stay was 3 days
• in 27.3%, length of stay was more than 4 days, with 82.7% due to medical causes, most often related to anemia that required blood transfusions and mobilization issues
• 6.9% were not discharged directly home, of which 68.4% had lengths of stay more than 4 days
• readmission rates were 14.2% at 30 days and 17.9% within 90 days after surgery, and 75.5% of readmissions within 90 days were medical, mainly due to falls and suspected but disproved venous thromboembolic events.

Further attention to pre- and postoperative anemia and the pathogenesis of medical complications is needed to improve outcomes, the authors say.

BACKGROUND: Elderly patients are at risk of increased length of hospital stay (LOS), postoperative complications, readmission, and discharge to destinations other than home after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Recent studies have found that enhanced recovery protocols or fast-track surgery can be safe for elderly patients undergoing these procedures and may result in reduced LOS.