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Irish Journal of Medical Science (1971 -)

Published in:

01-08-2017 | Original Article

Enhanced recovery in lower limb arthroplasty in the Irish setting

Authors: J. G. Galbraith, C. Fenelon, J. Gibbons, G. A. Kelly, D. Bennett

Published in: Irish Journal of Medical Science (1971 -) | Issue 3/2017

Abstract

Background

In the current economic climate of staff shortages and bed closures, orthopaedic surgeons must look for system efficiencies. Enhanced Recovery Programmes (ERP) have the potential not only to reduce length of stay (LOS) and concurrent costs but also to improve patient outcomes. The aim of this paper is to evaluate the effect of ERP for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) on length of stay (LOS) in the Irish Setting.

Methods

A single-surgeon retrospective case–control study was conducted comparing those who underwent primary lower limb arthroplasty before and after the introduction of an ERP. Patient medical and theatre records were used to determine the operation type, gender, age, LOS and readmission rates.

Results

Over the 2-year study period, a total of 310 patients underwent either THA (n = 244) or TKA (n = 66). The mean LOS was 8.79 days in the pre-ERP group and 5.1 days in the post-ERP group (p < 0.001). There was a significant correlation between LOS and age (p < 0.001). Gender or procedure type had no bearing on LOS for any of the subgroups (p > 0.1).

Conclusions

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.

Culliford D, Maskell J, Judge A, COASt Study Group et al (2015) Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthr Cartil 23:594–600CrossRefPubMed

Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMed

Losina E, Thornhill TS, Rome BN et al (2012) The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am 94:201–207CrossRefPubMedPubMedCentral

Malviya A, Martin K, Harper I et al (2011) Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthop 82:577–581CrossRefPubMedPubMedCentral

Antrobus JD, Bryson GL (2011) Enhanced recovery for arthroplasty: good for the patient or good for the hospital? Can J Anaesth 58:891–896CrossRefPubMed

Stowers MD, Lemanu DP, Coleman B et al (2014) Review article: Perioperative care in enhanced recovery for total hip and knee arthroplasty. J Orthop Surg (Hong Kong) 22:383–392CrossRef

Husted H, Jensen CM, Solgaard S et al (2012) Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Trauma Surg 132:101–104CrossRefPubMed

Husted H, Holm G, Jacoben S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173CrossRefPubMed

Larsen K, Sorensen OG, Hansen TB et al (2008) Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 79:149–159CrossRefPubMed

10.

Savaridas T, Serrano-Pedraza I, Khan SK et al (2013) Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4500 consecutive procedures. Acta Orthop 84:40–43CrossRefPubMedPubMedCentral

11.

Kociol RD, Lopes RD, Clare R et al (2012) International variation in and factors associated with hospital readmission after myocardial infarction. JAMA 307:66–74CrossRefPubMed

12.

Cram P, Lu X, Kaboli PJ et al (2011) Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008. JAMA 305:1560–1567CrossRefPubMedPubMedCentral

13.

Husted H, Otte KS, Kristensen BB et al (2010) Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg 130:1185–1191CrossRefPubMed

14.

Polanczk CA, Marcantonio E, Goldman L et al (2001) Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 134:637–643CrossRef

15.

Larsen K, Hansen TB, Soballe K et al (2010) Patient-reported outcome after fast-track hip arthroplasty: a prospective cohort study. Health Qual Life Outcomes 8:144CrossRefPubMedPubMedCentral

16.

Larsen K, Hansen TB, Thomsen PB et al (2009) Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. J Bone Joint Surg Am 91:761–772CrossRefPubMed

17.

Larsen K, Hvass KE, Hansen TB et al (2008) Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up. BMC Musculoskelet Disord 9:59CrossRefPubMedPubMedCentral

18.

Husted H, Otte KS, Kristensen BB et al (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605CrossRefPubMedPubMedCentral

19.

Glassou EN, Pedersen AB, Hansen TB (2014) Risk of re-admission, reoperation, and mortality within 90 days of total hip and knee arthroplasty in fast-track departments in Denmark from 2005 to 2011. Acta Orthop 85:493–500CrossRefPubMedPubMedCentral

20.

O’Callaghan A, Colgan MP, McGuigan C et al (2012) A critical evaluation of HIPE data. Ir Med J 105:21–23PubMed

Title: Enhanced recovery in lower limb arthroplasty in the Irish setting
Authors: J. G. Galbraith
C. Fenelon
J. Gibbons
G. A. Kelly
D. Bennett
Publication date: 01-08-2017
Publisher: Springer London
Published in: Irish Journal of Medical Science (1971 -) / Issue 3/2017
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI: https://doi.org/10.1007/s11845-017-1571-6

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Abstract

Background

Methods

Results

Conclusions

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