Enhanced recovery in lower limb arthroplasty in the Irish setting

Galbraith, John G.; Fenelon, Christopher; Gibbons, John A.; Kelly, Gemma; Bennett, Derek

doi:10.1007/s11845-017-1571-6

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…The key finding was that LoS was significantly associated with patient surgical and management factors. Patient age at surgery and the presence of comorbidities have been extensively reported as factors affecting LoS 4,5,10 and this was supported by the present findings. However, we also found that the time to first mobilization, discharge destination other than home, and the presence of complications also extended LoS.…”

Section: Discussionsupporting

confidence: 91%

“…ERP introduction has an excellent track record in reducing average LoS, including within the regional hospital setting. 3,4 In our regional hospital, efforts have been made to reduce LoS over a 5-year period, but as yet have not been documented into a formal protocol. Attempts to reduce LoS further cause concern for some members of the surgical community and other health care workers, due to the perceived elevated risk of hospital readmission after discharge.…”

mentioning

confidence: 99%

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Factors Affecting Hospital Length of Stay following Total Knee Replacement: A Retrospective Analysis in a Regional Hospital

Scholes¹,

Cowley²,

Ebrahimi³

et al. 2019

J Knee Surg

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In an effort to reduce hospital length of stay (LoS) following total knee arthroplasty (TKA), patient management strategies have evolved over time. The aims of this study were threefold: first, to quantify the reduction in LoS for TKA in a regional hospital; second, to identify the patient, surgical and management factors associated with hospital LoS; and lastly, to assess the change in complications incidence and hospital readmission as a function of LoS. A retrospective chart review was conducted on a consecutive series of primary and revision TKAs from January 2012 to March 2018. Factors describing patient demographics, as well as preoperative, intraoperative, surgical, and postoperative management, were extracted from paper and electronic medical records by a team of reviewers. Multivariate linear regression was performed to assess the association between these factors and LoS. In total, 362 procedures were included, which were reduced to 329 admissions once simultaneous bilateral procedures were taken into account. Median LoS reduced significantly (p = 0.001) from 6 to 2 days over the period of review. A stepwise regression analysis identified patient characteristics (age, gender, comorbidities, discharge barriers), perioperative management (anesthesia type), surgical characteristics (approach, alignment method), and postoperative management (mobilization timing, postoperative narcotic use, complication prior to discharge) as factors explaining 58.3% of the variance in LoS. Representation to emergency (6%) and hospital readmission (3%) remained low for the reviewed period. Efforts to reduce hospital LoS following TKA within a regional hospital setting can be achieved over time without significant increases in the rate or severity of complications or representation to acute care and subsequent readmission. The findings establish the role of patient, surgical and management factors in the context of agreed discharge criteria between care providers.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Factors Affecting Hospital Length of Stay following Total Knee Replacement: A Retrospective Analysis in a Regional Hospital

Scholes¹,

Cowley²,

Ebrahimi³

et al. 2019

J Knee Surg

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“…One important result from our study shows a shorter stay was not significantly associated with increased complications, proved also in a study by Scholes et al [1] . The former sentence is contrasted by Galbraith et al [7] , in his study stated that shorter hospital stays may reduce the quality of care and poorer outcomes if patients are discharged even before they are ready for it. Notably increasing age, female sex, presence of comorbids, presence of a complication, Low preoperative hemoglobulin and albumin, postoperative blood transfusion was associated with increased LOS and proved costly a treatment, burdening the patient.…”

Section: Discussionmentioning

confidence: 94%

“…Notably increasing age, female sex, presence of comorbids, presence of a complication, Low preoperative hemoglobulin and albumin, postoperative blood transfusion was associated with increased LOS and proved costly a treatment, burdening the patient. The patients' age at surgery and presence of comorbids has been extensively reported to increase LOS [1,2,4,5,7,8] younger age with decreased LOS are explained in literature [7] . Older patients are liable to be physically weak, furthermore, they need caregiver support than the younger age group which can increase LOS.…”

Section: Discussionmentioning

confidence: 99%

Factors determining the burden for patients of south Indian population following total knee replacement in terms of hospital stay: A retrospective single center study

Ashik¹,

Qamar²,

Prabaharan³

et al. 2021

Int. J. Orthop. Sci.

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Background: Total knee arthroplasty being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants & in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of LOS yet improving the functional outcome with better patient satisfaction. The purpose of this study is to identify the perioperative risk factors increasing the LOS of patients, by quantifying them, efforts can be done to manage those risks providing better satisfaction to patients. Materials and Methods:The study design is a retrospective analysis of 1022 patients of primary elective total knee arthroplasty, performed in our institution. The potential factors recorded were: age, sex, hemoglobin levels, albumin levels, BMI calculated with patients height and weight, ASA grading, smoking alcohol status, diagnosis for which TKA was done and comorbids were analysed Results: We looked at 1022 patients and found the average length of stay is 6 days, with age, comorbids, BMI, ASA, Diagnosis, blood transfusion, hemoglobin and albumin all played a role to influence Length of stay Conclusion: Our study showed that LOS after TKA is multifactorial. Various risk factors are present at the time of presentation, some of which are modifiable and some non-modifiable. It is important to acknowledge all the factors that increase the in-hospital LOS & to do one's uttermost use of medical resources.

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“…Since its inception in the early 2000s, the ERP has been introduced to a variety of different surgical specialties in the UK. It has been particularly popular in patients undergoing surgery for colorectal cancer, and in hip and knee arthroplasty in orthopaedics [ 13 , 14 ]. Although minor adaptations may be made to the ERP depending on the requirements of the pathologies it is set up to encompass, the emphasis remains on the optimization of the patient from the outset of admission.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Simple Cost Effective Interventions in Improving Enhanced Recovery in Neck of Femur Fracture Care

Wilson

Vala

O’Callaghan

et al. 2020

Cureus

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Aim Due to the frequency and high mortality and morbidity associated with neck of femur fractures, pathways of care have been established in the United Kingdom. These include the Enhanced Recovery Program (ERP), which aims to maximise the quality of care whilst reducing their length of stay, and the Best Practice Tariff (BPT) which if adhered to warrants £1335 per neck of femur fracture. We conducted a prospective audit to assess adherence to these pathways in a trauma unit. Methods An audit was carried out between November 2015 and May 2016. The information was obtained from neck of femur fracture proformas, anaesthetic charts and drug charts by two investigators. Results Nine out of the 10 ERP components were adhered to in all 31 patients. This highlighted a deficiency in requesting day one post-operative osteoporosis bloods, which was only carried out in 61.3% of patients. As an intervention, a reminder sticker was placed on the operation note as an intervention. Re-audit following the introduction of the stickers showed a marked improvement of 90%. During the initial admission 38.7% of patients adhered to the BPT. The main area for improvement was fracture prevention assessment, specifically Fracture Risk Assessment Tool (FRAX) scores and Nottingham Hip Fracture Scores. To improve this these sections were highlighted in the proformas to promote their importance. Additionally, a smartphone application was made available to doctors to aid with ease of calculation. Following these interventions, 93% of patients had this data entered, with an improvement in overall tariff attainment to 63.3%. Conclusions The introduction of simple measures is beneficial both for patient safety and economically for hospitals.

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Enhanced recovery in lower limb arthroplasty in the Irish setting

Abstract: ERP has the potential to significantly reduce overall length of stay after hip and knee arthroplasty and could have a considerable benefit in the Irish setting.

Cited by 11 publications

References 20 publications

Factors Affecting Hospital Length of Stay following Total Knee Replacement: A Retrospective Analysis in a Regional Hospital

Factors Affecting Hospital Length of Stay following Total Knee Replacement: A Retrospective Analysis in a Regional Hospital

Factors determining the burden for patients of south Indian population following total knee replacement in terms of hospital stay: A retrospective single center study

The Effect of Simple Cost Effective Interventions in Improving Enhanced Recovery in Neck of Femur Fracture Care

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