Acta Orthopaedica (Jan 2017)

Telemedicine support shortens length of stay after fast-track hip replacement: A randomized controlled trial

  • Martin Svoldgaard Vesterby,
  • Preben Ulrich Pedersen,
  • Malene Laursen,
  • Søren Mikkelsen,
  • Jens Larsen,
  • Kjeld Søballe,
  • Lene Bastrup Jørgensen

DOI
https://doi.org/10.1080/17453674.2016.1256939
Journal volume & issue
Vol. 88, no. 1
pp. 41 – 47

Abstract

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Background and purpose — Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement. Patients and methods — We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery. Results — Length of stay was reduced from 2.1 days (95% CI: 2.0–2.3) to 1.1 day (CI: 0.9–1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group. Interpretation — Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement.