Older patients have the most to gain from orthopaedic enhanced recovery programmes

Starks, Ian; Wainwright, Tom; Lewis, J.R.; Lloyd, John E.; Middleton, Robert

doi:10.1093/ageing/afu014

Cited by 67 publications

(62 citation statements)

References 22 publications

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“…16 However, more than 75% of those aged over 80 years had a LOS of less than four days and fast-track THA with discharge to home is feasible in most patients aged 85 years and over. Starks et al 17 found that in all age groups of THA and TKA patients, median LOS was reduced when compared with that before the introduction of a fast-track pathway. The reduction in LOS was most pronounced in patients aged 85 years and over and nearly all patients were discharged directly home.…”

Section: Pre-operative Optimisationmentioning

confidence: 99%

Fast track in hip arthroplasty

Hansen

2017

EFORT Open Reviews

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‘Fast-track’ surgery was introduced more than 20 years ago and may be defined as a co-ordinated peri-operative approach aimed at reducing surgical stress and facilitating post-operative recovery.The fast-track programmes have now been introduced into total hip arthroplasty (THA) surgery with reduction in post-operative length of stay, shorter convalescence and rapid functional recovery without increased morbidity and mortality. This has been achieved by focusing on a multidisciplinary collaboration and establishing ‘fast-track’ units, with a well-defined organisational set-up tailored to deliver an accelerated peri-operative course of fast-track surgical THA procedures.Fast-track THA surgery now works extremely well in the standard THA patient. However, all patients are different and fine-tuning of the multiple areas in fast-track pathways to get patients with special needs or high co-morbidity burden through a safe and effective fast-track THA pathway is important.In this narrative review, the principles of fast-track THA surgery are presented together with the present status of implementation and perspectives for further improvements.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160060. Originally published online at www.efortopenreviews.org

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Section: Pre-operative Optimisationmentioning

confidence: 99%

Fast track in hip arthroplasty

Hansen

2017

EFORT Open Reviews

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“…Adoption of enhanced recovery protocols for hip and knee arthroplasties have reduced the LOS. 9,13-16 However, early discharge from the hospital has the potential for wound complications being managed in the community and an increase in readmissions to hospital. This was recognised by the SSI reports and National Institute for Health and Care Excellence (NICE) publication on SSI arthroplasties.…”

Section: Introductionmentioning

confidence: 99%

Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties

Karlakki

Hamad

Whittall

et al. 2016

Bone & Joint Research

111

110

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ObjectivesWound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties.MethodsA total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group.ResultsAn improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06).ConclusionsBased on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res 2016;5:328–337. DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1

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“…There is very persuasive evidence and experience to support the use of enhanced recovery pathways for primary hip and knee replacement patients [10,16,17,18,19]). In their recent review article, Aasvang et al [20] summarise that ERAS can be routinely applied to all hip and knee replacement patients (with no age, pre-operative functional ability, or co-morbidity restrictions) to achieve a length of hospital stay from 1-3 days with discharge to home, and a reduced incidence of cardiac and venous thromboembolism complications, and reduced postoperative delirium and cognitive dysfunction.…”

Section: Eras Outcomes In Orthopaedic Surgerymentioning

confidence: 99%

“…Enhanced replacement pathways have also been found to be feasible and safe for more complex groups of patients such as the elderly [22]. A study by Starks et al [19] found that after the introduction of an enhanced recovery pathway, the most marked decrease in length of stay was for patients aged 85 years and over, with no negative effects on morbidity and mortality rates.…”

Section: Eras Outcomes In Orthopaedic Surgerymentioning

confidence: 99%