Enhanced Recovery After Surgery: An Orthopedic Perspective

Morrell, Aidan T.; Kates, Stephen L.; Lahaye, Laura A.; Layon, Daniel R.; Patel, Nirav K.; Scott, Michael J.; Golladay, Gregory J.

doi:10.1016/j.artd.2021.04.019

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…Enhanced Recovery After Surgery (ERAS) is a multimodal approach that is increasingly used in the care of surgical patients [ 56 ]. ERAS pathways for total joint arthroplasty lower costs, mortality and length of stay, and improve patient satisfaction [ 57 ], but fail to address many of the social and psychological aspects that are important to patients undergoing surgery. Building on the recent work showing that patient’s cognitive appraisal processes were critical in determining their functional outcome following THA [ 33 ], as well as the present work, preoperative identification of at-risk patients would be the first step in addressing this.…”

Section: Discussionmentioning

confidence: 99%

Appraisal and patient-reported outcomes following total hip arthroplasty: a longitudinal cohort study

Schwartz

Rapkin

Sniderman

et al. 2022

J Patient Rep Outcomes

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Background Total hip arthroplasty (THA) is a successful procedure that provides pain relief, restores function, and improves quality of life (QOL) for patients with advanced arthritis in their hip joint. To date, little research has examined the role of cognitive appraisal processes in THA outcomes. This study examined the role of cognitive appraisal processes in THA outcomes in the first year post-surgery. Methods This longitudinal cohort study collected data at pre-surgery, 6 weeks post-surgery, 3 months post-surgery, and 12 months post-surgery. Adults (n = 189) with a primary diagnosis of osteoarthritis were consecutively recruited from an active THA practice at a Canadian academic teaching hospital. Measures included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Mental Component Score (MCS) of the Rand-36, and the Brief Appraisal Inventory (BAI). Analysis of Variance examined the association between BAI items and the HOOS or MCS scores. Random effects models investigated appraisal main effects and appraisal-by-time interactions for selected BAI items. Results HOOS showed great improvement over the first 12 months after THA, and was mitigated by three appraisal processes in particular: focusing on problems with healthcare or living situation, and preparing one’s family for health changes. MCS was stable and low over time, and the following appraisal processes were implicated by very large effect sizes: not comparing themselves to healthier people, focusing on money problems, preparing their family for their health changes, or trying to shed responsibilities. Conclusions Appraisal processes are relevant to health outcomes after THA, with different processes coming into play at different points in the recovery trajectory.

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Section: Discussionmentioning

confidence: 99%

Appraisal and patient-reported outcomes following total hip arthroplasty: a longitudinal cohort study

Schwartz

Rapkin

Sniderman

et al. 2022

J Patient Rep Outcomes

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“…The growing emphasis on fast‐track surgery in arthroplasty centres, designed to enhance patient recovery and facilitate early discharge to home [12], underscores the importance of safe and comfortable wound care management. As patient expectations rise, there is a heightened focus on skin closure methods and dressing management [13].…”

Section: Introductionmentioning

confidence: 99%

Barbed sutures and skin adhesives improve wound closure in hip and knee arthroplasty

Romanini,

Zanoli,

Ascione

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to formulate evidence‐based recommendations for optimising wound management in hip and knee arthroplasty by exploring alternative methods such as barbed sutures and skin adhesives.MethodsA Delphi panel, comprising seven orthopaedic surgeons, one musculoskeletal infectious disease specialist, and one health economics expert, was convened to evaluate the use of barbed sutures and skin adhesives for wound closure in hip and knee arthroplasty. Two systematic reviews informed the development of questionnaires, with panelists ranking their agreement on statements using a 5‐point Likert scale. Consensus was achieved if ≥75% agreement. Unresolved statements were revisited in a second round.ResultsConsensus was reached on 11 statements, providing evidence‐based recommendations. The expert panel advocates for a multilayer watertight technique using barbed sutures to prevent surgical site infections (SSI), reduce complications, shorten surgical times, optimise resources and improve cosmetic appearance. For skin closure, the panel recommends topical adhesives to decrease wound dehiscence, enhance cosmetic appearance, promote patient compliance, prevent SSIs, and optimise resources.ConclusionThe Delphi consensus by Italian total joint arthroplasty experts underscores the pivotal role of barbed sutures and skin adhesives in optimising outcomes. While guiding clinical decision‐making, these recommendations are not prescriptive and should be adapted to local practices. The study encourages further research to enhance current evidence.Level of EvidenceLevel III.

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“…Despite pain reduction and physical function improvements from TKA, studies indicated that approximately 20% of patients reported dissatisfaction with the postoperative outcome (Hamilton et al, 2020) and might suffer from some common causes of failure, including infection, instability, shiftiness, failure of osseointegration and wear (Le et al, 2014). Because of the high volume of knee arthroplasty surgeries and the relatively suboptimal recovery status, recent evidence suggests optimizing enhanced recovery after surgery (ERAS) to improve the perioperative period with a faster and more effective clinical outcome and to reduce hospitalization (Morrell, Layon, et al, 2021); dedicated biopsychosocial multidisciplinary cooperation is a particularly effective means for optimizing ERAS (Morrell, Kates, et al, 2021). However, the evidence for ERAS optimization about TKA remains fairly sparse (Wainwright et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Predictors of psychological resilience trajectories in patients with knee arthroplasty: A longitudinal study

Shan

Liu

Chen

et al. 2022

Journal of Advanced Nursing

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Aims:To identify the different classes of total knee arthroplasty patients according to the heterogenous trajectories of psychological resilience and investigate the predictors for different patterns of resilience. Design: A prospective cohort study.Methods: A total of 210 patients with total knee arthroplasty from March to December 2021 were included. Baseline assessment (T0) data were collected before surgery and included demographic, biological (clinical characteristics), psychological (psychological resilience, self-efficacy, psychological distress, hope, medical coping mode) and social (social support) factors. Resilience measurements were repeated at 3 days after surgery (T1), the date of discharge (T2), and 1 month (T3) and 3 months (T4) after discharge. Latent growth mixture modelling was employed to define different resilience trajectories. Predictors of class membership were identified using multinomial logistic regression.Results: Data from 198 patients were analysed. Three latent classes were identified with similar patterns in different intercepts, showing a significant decrease in resilience from admission (T0) to 3 days after surgery (T1) followed by an increase from T1 to T4. The three trajectories of psychological resilience were named the stable-resilience class (65.66%), high-resilience class (17.68%), and low-resilience class (16.66%). Multinomial logistic regression showed that compared with the stableresilience class, the high-resilience class was predicted by having a higher level of hope, having higher education, living in urban areas and having more children, while the low-resilience class was predicted by having lower levels of self-efficacy and hope, living in semirural areas, and having more children. Conclusions:The three trajectories indicated that surgery was the major stressor influencing patients' psychological resilience and that patients in the low-resilience class needed to be intervened.

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Enhanced Recovery After Surgery: An Orthopedic Perspective

Cited by 3 publications

References 37 publications

Appraisal and patient-reported outcomes following total hip arthroplasty: a longitudinal cohort study

Appraisal and patient-reported outcomes following total hip arthroplasty: a longitudinal cohort study

Barbed sutures and skin adhesives improve wound closure in hip and knee arthroplasty

Predictors of psychological resilience trajectories in patients with knee arthroplasty: A longitudinal study

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