In pursuit of enhanced recovery after total joint replacement: a narrative review of drivers of length of stay

Rele, Siddharth; Dowsey, Michelle M.; Choong, Peter

doi:10.1111/ans.15790

Cited by 3 publications

(5 citation statements)

References 79 publications

(57 reference statements)

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“…However, the common comorbidities in this study including diabetes ( p = 0.688) and hypertension ( p = 0.189) were not significantly different between aggravation group and no aggravation group, and the same for ASA score ( p = 0.763). Moveover, risk factors [ 28 ] such as age [ 29 ], high BMI, frailty, anemia, and blood transfusions were involved with the length of stay while age ( p = 0.670) and BMI ( p = 0.537) did not differ significantly in our study. Thus, it can be hypothesized that frailty and poor health increase the length of stay, which account for this phenomenon, as frail patients face more severe challenges after SARS-COV-2 infection [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 61%

Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study

Chen,

Lai,

et al. 2024

J Orthop Surg Res

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Background The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19. Methods Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay. Results The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259–39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03–1.55, p = 0.027). Conclusion This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).

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Section: Discussionmentioning

confidence: 61%

Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study

Chen,

Lai,

et al. 2024

J Orthop Surg Res

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Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

“…ERAS protocols have even proven to reduce LOS in orthopaedic surgeries, including TJA. 29,30 Thus, the implementation of ERAS protocols may be an asset for the establishment of an outpatient TJA program.…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

“…Characteristics such as BMI and preoperative mobility status have been demonstrated to directly affect LOS with TJA. 30 Optimizing these factors through weight loss and preoperative rehabilitation may improve eligibility for the outpatient TJA. In addition to medical optimization, ERAS protocols also address the mental preparedness of patients for surgery.…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

“…The use of a tourniquet for TKA and infusion of antifibrinolytic medications (tranexamic acid) for both THA and TKA have demonstrated success in minimizing blood loss and decreasing LOS. 29,30 Postoperative protocols also contribute to early discharge. This includes adequate postoperative analgesia by the previously discussed methods, an adequate thromboembolic prophylaxis regimen, and prevention of postoperative nausea/vomiting.…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

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Current Trends and Future Directions for Outpatient Total Joint Arthroplasty: A Review of the Anesthesia Choices and Analgesic Options

Osman,

Tieu,

Caceres

et al. 2023

JAAOS Glob Res Rev

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The aging population and the obesity epidemic have led to an increased rate of joint arthroplasty procedures, specifically total knee arthroplasty and total hip arthroplasty. These surgeries are associated with increased hospital length of stay and, consequently, higher costs. Despite the benefits of outpatient surgery, only a small percentage of total joint arthroplasties (TJAs) are done in this manner. We reviewed the most up-to-date trends for outpatient TJA and discussed essential factors for a successful outpatient program, including the proper patient selection process and best available anesthetic and analgesic options, along with their risks and benefits. Risk stratification tools, such as the Outpatient Arthroplasty Risk Assessment, are helpful for predicting outcomes regarding outpatient TJA, and neuraxial anesthesia should be considered to minimize complications and facilitate early discharge. A multimodal analgesia regimen could be effective for pain management in outpatient TJA, and the currently recommended peripheral nerve blocks for total hip arthroplasty and total knee arthroplasty are the fascia iliaca compartment block and adductor canal block, respectively. However, blocks should be carefully considered for outpatient procedures. Enhanced recovery after surgery (ERAS) protocols help to guide perioperative care teams and allow for improved patient recovery, decreased length of stay, and increased patient satisfaction.

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Surgery for osteoarthritis

Choong

Dowsey

2023

Osteoarthritis Health Professional Training Manual

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In pursuit of enhanced recovery after total joint replacement: a narrative review of drivers of length of stay

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 3 publications

References 79 publications

Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study

Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study

Current Trends and Future Directions for Outpatient Total Joint Arthroplasty: A Review of the Anesthesia Choices and Analgesic Options

Surgery for osteoarthritis

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