2018
DOI: 10.1503/cjs.016117
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Optimizing outpatient total hip arthroplasty: perspectives of key stakeholders

Abstract: Background: Advances in surgical techniques combined with multimodal analgesia and early rehabilitation have potentiated early mobilization in patients undergoing total hip arthroplasty (THA). Given an increasing push from patients to accelerate recovery and health care budgetary limitations, there has been growing interest in the implementation of outpatient THA in selected patients. Understanding the patient and primary caregiver experience of outpatient THA is important to optimize care. We aimed to gain in… Show more

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Cited by 27 publications
(89 citation statements)
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“…49 With outpatient programs, patients become quickly responsible for their pain management and it was shown to often result in unrelieved pain. 45,50 When self-medicating, patients are often reluctant to take the prescribed analgesics because they are not sure when to take them or because they are afraid of developing an addiction. 45,46,50 Despite these additional challenges, our participants preferred the ERAS-outpatient pain management protocol that combined preemptive medication, dexamethasone, epidural-sedation anesthesia, local in ltration analgesia and multimodal analgesics over the STD-inpatient modalities that often included narcotics, because they felt it was more effective and they had less concern about developing a dependency.…”
Section: Pain Managementmentioning
confidence: 99%
“…49 With outpatient programs, patients become quickly responsible for their pain management and it was shown to often result in unrelieved pain. 45,50 When self-medicating, patients are often reluctant to take the prescribed analgesics because they are not sure when to take them or because they are afraid of developing an addiction. 45,46,50 Despite these additional challenges, our participants preferred the ERAS-outpatient pain management protocol that combined preemptive medication, dexamethasone, epidural-sedation anesthesia, local in ltration analgesia and multimodal analgesics over the STD-inpatient modalities that often included narcotics, because they felt it was more effective and they had less concern about developing a dependency.…”
Section: Pain Managementmentioning
confidence: 99%
“…A study by Churchill et al at our institution interviewed patients discharged as outpatients after THA and reported unrealistic expectations from the patients for speed of recovery as well as what to expect for post-operative pain. 27 Another significant patient factor is the presence of a caregiver post-surgery. Gromov et al (2017) excluded a large proportion of patients from outpatient discharge in their study because they lived alone.…”
Section: Patient Factorsmentioning
confidence: 99%
“…The study by Churchill et al reported that the presence of the caregiver when providing discharge instructions to patients may be important, as patients reported difficulties remembering what they had been told. 27 Appropriate access to home care services in the first few weeks post-surgery also helps caregivers and patients to feel more comfortable.…”
Section: Patient Factorsmentioning
confidence: 99%
“…The participants frequently reported relying on assistance from friends and family and often noted appreciation for the reported assistance. It is not surprising that caregiver support at home has been identified as a significant predictor of discharge following hip and knee total joint arthroplasty, as well as an important part of recovery and transition to home (Churchill et al, 2018;Halawi et al, 2015). However, the level of support required after arthroplasty in general, let alone SA specifically, is a largely under researched topic.…”
Section: Implications For Future Researchmentioning
confidence: 99%
“…One study by Zadzilka et al (2018) noted that caregiver burden following knee arthroplasty was significantly improved at 1 month versus 1 year following surgery. Other researchers identified the importance of caregivers having a support network following surgery (Churchill et al, 2018). Future qualitative studies, including studies interviewing the caregiver, may provide more accurate insight into the recovery process of those who are dependent on others for assistance in the first few stages of rehabilitation as well as an understanding of caregiver burden.…”
Section: Implications For Future Researchmentioning
confidence: 99%