Acta Chir Orthop Traumatol Cech. 2020; 87(3):197-202 | DOI: 10.55095/achot2020/032

Early Mobilization and Functional Discharge Criteria Affecting Length of Stay after Total Elbow ArthroplastyOriginal papers

A. PRKIĆ1,*, J. VIVEEN1, B. THE1, K.L.M. KOENRAADT2, D. EYGENDAAL1,3
1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
2 Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, The Netherlands
3 Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands

PURPOSE OF THE STUDY:
Decline in length of stay is of growing interest for patients, doctors and health insurances. The aim of our study was to assess the safety and length of stay after omission of casting, start of early mobilization and implementation of functional discharge criteria after total elbow arthroplasty (TEA).

MATERIAL AND METHODS:
We retrospectively reviewed all patients' records who received a Coonrad-Morrey TEA in the period from January 1st, 2011 to December 31st, 2018. From these records, indications, demographic information and complications were derived. Length of stay was calculated from the hospital administration. Patients were divided in three groups to evaluate the two changes in post-operative care.

RESULTS:
In total 125 patients receiving 126 Coonrad-Morrey TEAs were included with a mean length of stay of 5.5 days (range 2-23) for the entire group. Omitting a post-operative cast led to decline in length of stay from 6.2 to 5.4 days (p < 0.001). Introduction of functional discharge criteria in August 2017 declined mean length of stay to 3.8 days (p < 0.001). The surgical technique (triceps-on versus triceps-off) was not a confounder (p = 0.20). Range of motion after one year was not significantly different between groups.

DISCUSSION:
The length of stay declined after omission of a cast, and declined further after introducing functional discharge criteria. Since no higher complication rates were observed, the shortening of length of stay appears to be safe. This is in line with other fast-track programs, i.e. for hip and knee arthroplasty. The surgical technique used were not a confounder for the shortened length of stay, which further adds to the safety of the functional discharge criteria.

CONCLUSIONS:
Omitting a cast and splint as regular post-operative treatment reduced the length of stay significantly without leading to more complications. Introduction of functional discharge criteria lowered the length of stay further without more complications.

Keywords: fast track rehabilitation, cast, total elbow arthroplasty, length of stay, discharge, complications

Published: June 1, 2020  Show citation

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PRKIĆ A, VIVEEN J, THE B, KOENRAADT KLM, EYGENDAAL D. Early Mobilization and Functional Discharge Criteria Affecting Length of Stay after Total Elbow Arthroplasty. Acta Chir Orthop Traumatol Cech. 2020;87(3):197-202. doi: 10.55095/achot2020/032. PubMed PMID: 32773021.
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    References

    1. Albert B, Lee A, McLendon T, Devereaux R, Odum C, Foulkes G. Is total elbow arthroplasty safe as an outpatient procedure? J Surg Orthop Adv. 2017;26: 25-28. Go to original source... Go to PubMed...
    2. Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: Time for reconsideration? Arch Phys Med Rehabil. 2012;93:1292-1294. Go to original source... Go to PubMed...
    3. Booker SJ, Smith CD. Triceps on approach for total elbow arthroplasty: worth preserving? A review of approaches for total elbow arthroplasty. Shoulder Elbow. 2017;9:105-111. Go to original source... Go to PubMed...
    4. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79:168-173. Go to original source... Go to PubMed...
    5. Ilfeld BM, Wright TW, Enneking FK, Vandenborne K. Total elbow arthroplasty as an outpatient procedure using a continuous infraclavicular nerve block at home: a prospective case report. Reg Anesth Pain Med. 2006;31:172-176. Go to original source... Go to PubMed...
    6. Jørgensen CC, Kehlet H. Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand. 2013;57:631-638. Go to original source... Go to PubMed...
    7. Larsen JR, Skovgaard B, Prynø T, Bendikas L, Mikkelsen LR, Laursen M, Høybye MT, Mikkelsen S, Jørgensen LB. Feasibility of day-case total hip arthroplasty: a single-centre observational study. Hip Int. 2017;27:60-65. Go to original source... Go to PubMed...
    8. Lovy AJ, Keswani A, Dowdell J, Koehler S, Kim J, Hausman MR. Outcomes, complications, utilization trends, and risk factors for primary and revision total elbow replacement. J Shoulder Elbow Surg. 2016;25:1020-1026. Go to original source... Go to PubMed...
    9. Lunn TH, Kristensen BB, Gaarn-Larsen L, Kehlet H. Possible effects of mobilisation on acute post-operative pain and nociceptive function after total knee arthroplasty. Acta Anaesthesiol Scand. 2012;56:1234-1240. Go to original source... Go to PubMed...
    10. Maloney WJ, Schurman DJ. Cast immobilization after total elbow arthroplasty. Clin Orthop Relat Res. 1989;245:117-122. Go to original source...
    11. Pope D, Scaife SL, Tzeng TH, Vasdev S, Saleh KJ. Impact of diabetes on early postoperative outcomes after total elbow arthroplasty. J Shoulder Elbow Surg. 2015;24:348-352. Go to original source... Go to PubMed...
    12. Specht K, Kjaersgaard-Andersen P, Kehlet H, Wedderkopp N, Pedersen BD. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement. Acta Orthop. 2015;86:702-707. Go to original source... Go to PubMed...
    13. Specht K, Kjaersgaard-Andersen P, Pedersen BD. Patient experience in fast-track hip and knee arthroplasty - a qualitative study. J Clin Nurs. 2016;25: 836-845. Go to original source... Go to PubMed...
    14. Stone MA, Singh P, Rosario SL, Omid R. Outpatient total elbow arthroplasty: 90-day outcomes. J Shoulder Elbow Surg. 2018;27:1311-1316. Go to original source... Go to PubMed...
    15. Toor AS, Jiang JJ, Shi LL, Koh JL. Comparison of perioperative complications after total elbow arthroplasty in patients with and without diabetes. J Shoulder Elbow Surg. 2014;23:1599-1606. Go to original source... Go to PubMed...

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