TOTAL KNEE REPLACEMENT - A GUIDELINE TO REDUCE POSTOPERATIVE LENGTH OF STAY

In a retrospective study in an academic, acute-care community hospital , we studied the possible safety and effectiveness of a practice guide line recommending early discharge from the hospital for patients havin g uncomplicated total knee replacement. Of 206 patients receiving knee replacements, 162 (79%) were classified by the guideline as being at low risk for complications between the 4th and 7th postoperative days. Use of the guideline could have reduced the postoperative length of s tay from 7.3 +/- 2.6 days to 4 days for the 112 patients (54%) who bec ame low risk on the 4th postoperative day. Explicit and implicit revie w of the quality of care determined that 157 patients (96.9%; 95% conf idence interval, 92.9%, 99.0%) could have been safely transferred from the acute-care hospital to an appropriate setting when they became cl assified at low risk between the 4th and 7th postoperative days. Clini cal practice guidelines can possibly be used to reduce the postoperati ve length of acute-care hospital stay for patients having knee replace ments. This guideline requires further study in a controlled clinical trial before it can be recommended for use.