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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study

Authors: U. Plenge, M. B. Nortje, L. C. Marais, J. D. Jordaan, R. Parker, N. van der Westhuizen, J. F. van der Merwe, J. Marais, W. V. September, G. L. Davies, T. Pretorius, C. Solomon, P. Ryan, A. M. Torborg, Z. Farina, R. Smit, C. Cairns, H. Shanahan, S. Sombili, A. Mazibuko, H. R. Hobbs, O. S. Porrill, N. E. Timothy, R. E. Siebritz, C. van der Westhuizen, A. J. Troskie, C. A. Blake, L. A. Gray, T. W. Munting, H. K. S. Steinhaus, P. Rowe, J. G. van der Walt, R. Isaacs Noordien, A. Theron, B. M. Biccard

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs.

Methods

Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty.

Results

Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category.

Conclusion

The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.
Footnotes
1
* Human Development Index (HDI) is an index based on i) life expectancy, ii) education and iii) per capita income indicators, which is used to determine whether a nation is a developed or a developing country.
 
Literature
1.
Alfonsi P, Slim K, Chauvin M, Mariani P, Faucheron JL, Fletcher D. French guidelines for enhanced recovery after elective colorectal surgery. J Visc Surg. 2014;151(1):65–79.CrossRefPubMed
2.
Simpson JC, Moonesinghe SR, Grocott MP, Kuper M, McMeeking A, Oliver CM, Galsworthy MJ, Mythen MG, National Enhanced Recovery Partnership Advisory B. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009-2012. Br J Anaesth. 2015;115(4):560–8.CrossRefPubMed
3.
Scott MJ, McEvoy MD, Gordon DB, Grant SA, Thacker JKM, Wu CL, Gan TJ, Mythen MG, Shaw AD, Miller TE. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 2-from PACU to the transition home. Perioper Med (Lond). 2017;6:7.CrossRef
4.
5.
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606–17.CrossRefPubMed
6.
Scott NB, McDonald D, Campbell J, Smith RD, Carey AK, Johnston IG, James KR, Breusch SJ. The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units--an implementation and follow-up at 1 year, 2010-2011: a report from the musculoskeletal audit, Scotland. Arch Orthop Trauma Surg. 2013;133(1):117–24.CrossRefPubMed
7.
Kehlet H. Fast-track hip and knee arthroplasty. Lancet (London, England). 2013;381(9878):1600–2.CrossRef
8.
Zhu S, Qian W, Jiang C, Ye C, Chen X. Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J. 2017;93:736.CrossRefPubMedPubMedCentral
9.
Kash BA, Zhang Y, Cline KM, Menser T, Miller TR. The perioperative surgical home (PSH): a comprehensive review of US and non-US studies shows predominantly positive quality and cost outcomes. Milbank Q. 2014;92(4):796–821.CrossRefPubMedPubMedCentral
10.
11.
12.
Biccard BM, Madiba TE, Kluyts HL, Munlemvo DM, Madzimbamuto FD, Basenero A, Gordon CS, Youssouf C, Rakotoarison SR, Gobin V, et al. Perioperative patient outcomes in the African surgical outcomes study: a 7-day prospective observational cohort study. Lancet (London, England). 2018;391:1589.CrossRef
13.
Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet (London, England). 2015;386(9993):569–624.CrossRef
14.
15.
Hsu C-C, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007;12(10):1–8.
16.
Campbell RJ. Change management in health care. Health Care Manag (Frederick). 2008;27(1):23–39.
17.
Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6(6):e20476.CrossRefPubMedPubMedCentral
18.
Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, Marteau T: Consensus development methods, and their use in clinical guideline development. Health Technol Assess 1998, 2(3):i-iv, 1-88.
19.
Minas H, Jorm AF. Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities. Int J Ment Health Syst. 2010;4:33.CrossRefPubMedPubMedCentral
20.
Pearse RM, Holt PJ, Grocott MP. Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ. 2011;343:d5759.CrossRefPubMed
21.
Bainbridge D, Martin J, Arango M, Cheng D, Evidence-based Peri-operative Clinical Outcomes Research G. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet. 2012;380(9847):1075–81.CrossRefPubMed
22.
Levett DZH, Edwards M, Grocott M, Mythen M. Preparing the patient for surgery to improve outcomes. Best Pract Res Clin Anaesthesiol. 2016;30(2):145–57.CrossRefPubMed
23.
Garson L, Schwarzkopf R, Vakharia S, Alexander B, Stead S, Cannesson M, Kain Z. Implementation of a total joint replacement-focused perioperative surgical home: a management case report. Anesth Analg. 2014;118(5):1081–9.CrossRefPubMed
24.
Myles PS, Grocott MP, Boney O, Moonesinghe SR, Group CO-S. Standardizing end points in perioperative trials: towards a core and extended outcome set. Br J Anaesth. 2016;116(5):586–9.CrossRefPubMed
25.
Singh JA, Dowsey MM, Dohm M, Goodman SM, Leong AL, Scholte Voshaar MM, Choong PF. Achieving consensus on total joint replacement trial outcome reporting using the OMERACT filter: endorsement of the final core domain set for total hip and total knee replacement trials for endstage arthritis. J Rheumatol. 2017;44:1723.CrossRefPubMed
Metadata
Title
Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study
Authors
U. Plenge
M. B. Nortje
L. C. Marais
J. D. Jordaan
R. Parker
N. van der Westhuizen
J. F. van der Merwe
J. Marais
W. V. September
G. L. Davies
T. Pretorius
C. Solomon
P. Ryan
A. M. Torborg
Z. Farina
R. Smit
C. Cairns
H. Shanahan
S. Sombili
A. Mazibuko
H. R. Hobbs
O. S. Porrill
N. E. Timothy
R. E. Siebritz
C. van der Westhuizen
A. J. Troskie
C. A. Blake
L. A. Gray
T. W. Munting
H. K. S. Steinhaus
P. Rowe
J. G. van der Walt
R. Isaacs Noordien
A. Theron
B. M. Biccard
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2062-2

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