NEW YORK (Reuters Health) – Fast-track rehabilitation is not only feasible but may be particularly beneficial for patients age 85 and older who undergo elective joint replacement, a new study has found.
Fast tracking shortened hospital stays for all patients who had either hip or knee replacement at one medical center, from six days to four days. For patients age 85 years and older, the fast-track program reduced length of stay from nine days to five days for hip replacements and from eight days to five days for knee replacements, the study found.
“We should be adopting standardized evidenced-based (‘enhanced recovery’) pathways for everyone undergoing joint replacement surgery with very few exceptions. Whereas most of the research to date has focused on the younger end of the spectrum, it is the elderly that have the most to gain from such pathways, with growing evidence for a reduction in morbidity and mortality,” lead author Dr. Ian Starks, an orthopedic physician at Wrexham Maelor Hospital in Wrexham, UK, told Reuters Health by email.
Dr. Starks and his team published their findings online March 13 in Age and Ageing.
Fast tracking, or enhanced recovery programs, engage patients to participate in their own recovery through multidisciplinary, evidenced-based patient education and surgical techniques, the researchers write.
Specifically, their program involved pre-operative assessment, patient education, and discharge planning; day of surgery admission with standardized antibiotic prophylaxis and spinal anesthesia; and post-operative standardized analgesic ladder, early physiotherapy and mobilization, and promotion of independence and wellness.
Past studies have underscored the benefits of such programs to younger patients, but the new research suggests elderly patients may stand to benefit most.
The researchers examined records from 2128 patients at a single medical center. They found the median length of stay at their center after fast tracking hip and knee replacement patients of all ages was shorter than it was before they began the fast-track program. It was also shorter than the national average (five days). When they separated out the patients who were ages 85 and older, the differences were more pronounced.
The readmission rate was 4.7% for all patients combined, comparable to before the program. There were no deaths within 30 days.
The fact that older patients benefited most from fast tracking was not a surprise, Dr. Starks said, but the degree of benefit was.
“I was surprised by the magnitude of the improvements. The reduction in morbidity and potentially mortality was particularly interesting,” Dr. Starks said.
By Rob Goodier
April 09, 2014