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Vol. 61. Issue 2.
Pages 111-116 (March - April 2017)
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Vol. 61. Issue 2.
Pages 111-116 (March - April 2017)
Original Article
DOI: 10.1016/j.recote.2017.02.004
Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications
Técnica de recuperación acelerada (fast-track) aplicada a cirugía protésica primaria de rodilla y cadera. Análisis de costos y complicaciones
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C. Wilchesa,
Corresponding author
cwilches@csa.cat

Corresponding author.
, J.D. Sulbarána, J.E. Fernándeza, J.M. Gisberta, J.M. Bausilib, X. Pelforta
a Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Igualada. Consorci Sanitari de l’Anoia, Igualada, Barcelona, Spain
b Servicio de Anestesiología y Reanimación, Hospital General de Igualada. Consorci Sanitari de l’Anoia, Igualada, Barcelona, Spain
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Tables (4)
Table 1. Differences between the recovery protocols.
Table 2. Calculation of costs per day of admission in primary knee arthroplasty.
Table 3. Comparison of demographic and follow-up variables.
Table 4. Regression coefficients of the hierarchical linear regression model with age and intervention group as predictive variables of the mean stay.
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Abstract
Purpose

To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates.

Materials and methods

Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups.

Results

Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266euros for TKR and 583euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months.

Discussion

There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266euros for the TKR group and 583 for the THR group, without affecting complication rates.

Keywords:
Total knee replacement
Total hip replacement
Rapid recovery
Fast-track recovery
Resumen
Objetivo

Determinar el ahorro económico que supone la implantación de un sistema de recuperación rápida (fast-track) al compararlo con el método de recuperación convencional en artroplastia primaria de cadera (ATC) y rodilla (ATR). Asimismo, determinar si existen diferencias entre ambos en el índice de complicaciones.

Material y métodos

Estudio retrospectivo descriptivo, incluyendo 100 artroplastias primarias utilizando el método fast-track y 100 utilizando recuperación convencional. Las variables comparadas entre ambos grupos fueron edad, sexo, índice de comorbilidad de Charlson, ASA, estancia media, complicaciones intrahospitalarias y durante los primeros seis meses e índice de reingresos y transfusiones. Se determinó el coste global para cada procedimiento y por día de ingreso, y el ahorro se calculó según la reducción de la estancia media.

Resultados

Ambos grupos fueron comparables en cuanto a edad, sexo, ASA e índice de Charlson. La reducción de la estancia media hospitalaria fue de 4,5 días para el grupo de ATR y 2,1 días para el de ATC. El ahorro calculado fue de 1.266 euros para el grupo de ATR y de 583 euros en el de ATC. No se observaron diferencias significativas en cuanto a complicaciones intrahospitalarias, necesidad de transfusiones, reingresos y complicaciones durante los primeros 6 meses.

Discusión

Existen pocos trabajos de análisis de costos en relación con la implantación de sistemas de recuperación rápida en cirugía protésica. Diversas series publicadas tampoco observaron un mayor índice de complicaciones utilizando este método. La utilización del método fast-track representó un ahorro de 1.266 euros para el grupo de ATR y de 583 euros para el grupo de ATC sin aparente repercusión sobre el índice de complicaciones.

Palabras clave:
Artroplastia total de rodilla
Artroplastia total de cadera
Recuperación rápida
Recuperación fast-track

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