DOS 2016

DOS Kongressen 2016 ·

Causes of Prolonged Length of Stay and Readmissions

after “Fast-Track” Total Knee Arthroplasty.

Martin Lindberg-Larsen, Mette Hornsleth, Jens Bagger, Susanne van der Mark

Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg

Background:

The Danish Knee Arthroplasty Annual Report 2015 indicated a

high 30 day readmission rate after primary total knee arthroplasty (TKA) per-

formed at Bispebjerg Hospital in 2014.

Purpose / Aim of Study:

To investigate causes of prolonged length of stay

(LOS) and readmissions ≤ 30 days post-operatively.

Materials and Methods:

A retrospective analysis of 175 patients operated

with TKA in 2014. Patient characteristics were available from The Lundbeck

Foundation Centre for Fast-Track Hip and Knee Replacement Database (LCDB)

and readmissions/transferals from Danish National Patient Register and patient

files.

Findings / Results:

Comparing patient characteristics with the LCDB popula-

tion, we found that 43% lived alone (vs 31%, p=0.019), 20% smoked (vs 13%,

p=0.027) and 16% were alcohol abusers (vs 7%, p<0.001). Median LOS was

2 days, but 29 patients were internally transfered from the elective fast-track

unit to other wards resulting in increased LOS (13 to ortho-geriatric unit). Main

causes of transferal were need of further mobilization (9) and serious medical

complications (13). A total of 19 (10.9%) patients were readmitted ¡Ü30 days

postoperatively. Most frequent causes of readmissions were suspected DVT

(8), suspected infection (1) or suspected myocardial infarction (1), but dis-

proved in all cases. Need of further mobilization caused readmission in 4 cases.

More serious causes of readmission were infection (1), fall (1), anaemia (1),

hypoglycemia (1) and gastro-intestinal bleeding (1).

Conclusions:

17% of the patients could not adhere to the fast-track proto-

col and >50% of readmissions were non-serious and should not have caused

readmission. Preventing unnecessary readmissions is a future focus as well as

further improvement of the combined ortho- geriatric and fast-track set-up to

optimize the treatment of elderly patients with increased co-morbidity.

No conflicts of interest reported

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