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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Hip-TEP | Research article

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Authors: Ulla Plenge, Romy Parker, Shamiela Davids, Gareth L. Davies, Zahnne Fullerton, Lindsay Gray, Penelope Groenewald, Refqah Isaacs, Ntambue Kauta, Frederik M. Louw, Andile Mazibuko, David M. North, Marc Nortje, Glen M. Nunes, Neo Pebane, Chantal Rajah, John Roos, Paul Ryan, Winlecia V. September, Heidi Shanahan, Ruth E. Siebritz, Rian W. Smit, Simon Sombili, Alexandra Torborg, Johan F. van der Merwe, Nico van der Westhuizen, Bruce Biccard

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

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Abstract

Background

Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice.

Methods

From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice.

Results

Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%).

Conclusion

Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative.

Trial registration

The study was registered with ClinicalTrials.gov (NCT03540667).
Appendix
Available only for authorised users
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Metadata
Title
Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study
Authors
Ulla Plenge
Romy Parker
Shamiela Davids
Gareth L. Davies
Zahnne Fullerton
Lindsay Gray
Penelope Groenewald
Refqah Isaacs
Ntambue Kauta
Frederik M. Louw
Andile Mazibuko
David M. North
Marc Nortje
Glen M. Nunes
Neo Pebane
Chantal Rajah
John Roos
Paul Ryan
Winlecia V. September
Heidi Shanahan
Ruth E. Siebritz
Rian W. Smit
Simon Sombili
Alexandra Torborg
Johan F. van der Merwe
Nico van der Westhuizen
Bruce Biccard
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Hip-TEP
Hip-TEP
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03752-x

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