Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

Harkouk, Hakim; Capmas, P.; Derridj, Nawal; Belbachir, A.; Nkam, Lionelle; Aegerter, Philippe; Battaglia, Eva; Tharel, Laure; Fletcher, Dominique

doi:10.1186/s13741-021-00200-9

Cited by 1 publication

(2 citation statements)

References 20 publications

(23 reference statements)

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“…The study and participant characteristics of the 49 included studies as well as a description of the shortstay and usual care groups are shown in Table 1. They were published from 2005 to 2023 and originated from sixteen countries: thirteen from the United Kingdom (UK) [25][26][27][28][29][30][31][32][33][34][35][36][37], seven from the United States (US) [38][39][40][41][42][43][44], four from China [45][46][47][48], three studies each from France [49][50][51], Italy [52][53][54] and the Netherlands [55][56][57], two studies each from Canada [58,59], Denmark [60,61], New Zealand [62,63], and Sweden [64,65], and one study each from Australia [66], Brazil [67], Germany [68], India [69], Ireland …”

Section: Trial Design Setting and Characteristicsmentioning

confidence: 99%

“…(3) preoperative carbohydrate and/or protein loading to reduce the metabolic stress of starvation [27, 46-48, 60, 69, 72], (4) preoperative staff education on short-stay joint replacement programmes [28,31,34,49,58,60,69], (5) hypnotics to promote patient compliance with early mobilisation [45], (6) wearing patients' own clothes during admission to promote patient comfort and satisfaction [43,60], (7) not using negative vacuum suction drains [69,71], [8] low tidal volume ventilation strategy to prevent ventilator-associated lung injury [38,62], (9) higher dose of steroids [45], and (11) preoperative physiotherapy [73].…”

Section: Intervention Characteristicsmentioning

confidence: 99%

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A systematic review and meta-analysis of short-stay programmes for total hip and knee replacement, focusing on safety and optimal patient selection

Berkovic,

Vallance,

Harris

et al. 2023

BMC Med

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Background Short-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection. Methods A systematic review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed. Results Forty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12–7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27–11.36); neurovascular injury (OR 0.31, 95% CI 0.01–7.92); other complications (OR 0.63, 95% CI 0.26–1.53); or stiffness (OR 1.04, 95% CI 0.53–2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814). Conclusions There is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.

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