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Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011-2015: an observational study including 51,169 THR and 8,393 TKR operations

Journal article
Authors Urban Berg
A. W-Dahl
Ola Rolfson
E. Naucler
M. Sundberg
Anna Nilsdotter
Published in Acta Orthopaedica
Volume 91
Issue 3
Pages 306-312
ISSN 1745-3674
Publication year 2020
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 306-312
Language en
Links dx.doi.org/10.1080/17453674.2020.17...
Keywords quality-of-life, enhanced recovery, tourniquet use, elective hip, arthroplasty, experience, surgery, osteoarthritis, satisfaction, length, Orthopedics
Subject categories Orthopedics

Abstract

Background and purpose - Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers. Patients and methods - Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011-2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS. Results - The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens' d formula were < 0.2 for all PROs, in both THR and TKR. Interpretation - Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.

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