Fast Track Surgery na artroplastia total do quadril: custo-efetividade

Abstract

Fast track surgery (FTS) is an evidence-based, multimodal approach that can reduce the time to convalescence and improve clinical outcomes, including reductions in morbidity and mortality, significantly reducing the time taken to reach hospital discharge and optimizing patient satisfaction. The main strategy consists of five steps: careful patient selection, improving preoperative care, minimizing perioperative stress, decreasing postoperative discomfort, and improving postoperative recovery. In this context, the aim of this thesis was to analyze whether an accelerated recovery protocol (FTS) developed for THA could reduce the lenght of stay (LOS) and hospital costs. This is an observational coorte with a retrospective group composed of patients who underwent conventional surgery in the period between January 2012 and November 2016 and another propective group composed of patients operated in the period between December 2016 and December 2018, using the FTS protocol. LOS and cost-effectiveness were evaluated as primary outcomes. The need for ICU, the use of blood transfusion and complications were analyzed as secondary outcomes. The FTS and control groups were similar in age distribution , and most patients were older than 50 years. Distribution by sex, ASA score, hypertension, type 2 diabetes and obesity did not differ between the two groups. The cementation and implant characteristics were similar between the two groups. In the control group 74.5% of patients required blood transfusion and 72.5% were referred to the ICU postoperatively, while in the FTS group 4.2% of patients received blood transfusion and 2.1% were referred to the ICU in the postoperative period. No patient in the FTS group remained hospitalized for more than six 6 days, while for 56.8% of controls the time elapsed until hospital discharge was seven or more days. Mean LOS in the FTS group was 2.3 ± 0.8 days compared with 6.4 ± 1.5 days in the control group. There was a significant reduction in direct and indirect costs. It is concluded that the FTS protocol in THA was associated with a reduction in TPH and a decrease in intraoperative blood loss compared to the conventional group. The need for ICU support was rationalized. The overall cost reduction was 66.1% without increasing the rates of clinical complications, readmission or mortality.