Shorter hospital stays after hip and knee surgery

It is no longer uncommon to see the elderly leaving hospital for home only a few days after they have been given a new knee or hip. A new scientific study, recently published in the Danish Medical Journal, indicates that the need for a hospital stay after this type of surgery is steadily declining:

– Today, many patients go home on the day they received surgery. And most of those who are not able to go straight home are only hospitalised for one or two days, compared with three to four days in 2010.
– If we look at the patients who remain in hospital longer than four days after surgery, this group decreased by more than half between 2010 and 2017: from 9.6 to 4.4%.
– It is also important to point out that these improvements have not increased the need for readmission due to long-term complications from surgery.

It is quite staggering that elderly patients can often be sent home for rehabilitation one to two days after they have received a new knee or hip. Up to only a few years ago, we would not have thought this possible – but it is a reality in Denmark today. ‘And the experiences we’re gaining in orthopaedic surgery may also have a positive impact on other fields of surgery,’ says Henrik Kehlet, who is professor of surgical pathophysiology at Rigshospitalet, University of Copenhagen, head of the Centre for Fast-Track Hip and Knee Surgery and the man behind this report. Over the years, Professor Kehlet has published more than 130 scientific papers.

The centre is a collaboration – and continual exchange of expertise and experience – between ten Danish hospitals, and, funded by the Lundbeck Foundation, their aim is to design a surgical programme with increased focus on treatment quality and patient safety.

Factors such as pain management, infection risk and prevention of strokes are in the spotlight. ‘And once we’ve managed this, in addition to improved patient safety and treatment quality, we may also be able to reap socio-economic benefits in the form of shorter hospital stays,’ says Pelle Baggesgaard Petersen, doctor, PhD student at the Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, and first author of the new scientific article.

Model surgeries
The scientific article is based on a total of 36,000 knee and hip operations performed in Denmark between 2010 and 2017. And the doctors were subsequently able to keep track of individual patients with the help of anonymised patient data.

This is a huge number of operations – typically performed on patients past pensionable age, when severe wear and tear of hips and knees tends to appear, if indeed it does.

Looking at hips and knees has given doctors access to a significant volume of data without the need to collect data over the course of many years. It also allowed them to track the impact of initiatives which have been launched at Danish hospitals based on experience gained from the Fast-Track project.

Professor Kehlet explains that knee and hip surgery should also be regarded as model surgeries in a broader context:

‘It’s all about being aware of the risks involved in surgery. Orthopaedic surgeries have really taught us a lot, and this knowledge can be used to optimise other types of surgery. And the two key questions in this context are: Why is the patient in hospital? And what are their issues after they’ve been discharged?’