Superior Functional Outcome and Comparable Health-Related Quality of Life after Enhanced Recovery vs. Conventional THA: A Retrospective Matched Pair Analysis

Leiß, Franziska; Schindler, Melanie; Götz, Julia; Maderbacher, Günther; Meyer, M.; Reinhard, Jan; Zeman, Florian; Grifka, Joachim; Greimel, Felix

doi:10.3390/jcm10143096

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…Propensity score was estimated by binary logistic regression, considering gender, age, BMI, and tumor maximal diameter to adjust for potential baseline confounders (12). Continuous variables comparisons were conducted by student's t-test or Mann-Whitney test, and categorical variables by Pearson's chi-square or Fisher's exact test.…”

Section: Discussionmentioning

confidence: 99%

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

Nian¹,

Ye²,

Zhang³

et al. 2022

Transl Androl Urol

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Background: Open radical nephrectomy (ORN) is a practical procedure for treating patients with large renal carcinomas >10 cm in size, and few studies have focused on feasibility and safety of laparoscopic radical nephrectomy (LRN). The current study was to assess the safety and effectiveness of LRN and ORN in large renal carcinoma patients by propensity matched pair analysis. Methods: In this cohort study, a retrospective review of radical nephrectomy data from October 2010 to October 2018 at Changhai Hospital was conducted. Patients with renal carcinomas >10 cm in size by preoperative images were included. Patients' demographics including age, gender, body mass index (BMI), tumor size, operation time, hospitalization days, etc. were collected. Renal tumor patients undergoing LRN or ORN were match-paired by gender, BMI, age, and tumor size. Peri-operative outcomes including estimated blood loss and complications were compared. The follow-up contents included survival time, disease progression, and cause of death, and cancer-specific and progression-free survival were estimated via Kaplan-Meier curve analysis.Results: Among 92 patients with clinical T2b renal masses, 37 pairs were matched. The average tumor sizes of the LRN and ORN groups were 11.37±0.30 and 11.67±0.33 cm (P=0.375), respectively. The average operating time for LRN was slightly longer (204.32±11.17 vs. 192.78±8.50 min, P=0.414). Estimated blood loss (EBL) (336.49±63.58 mL for LRN vs. 545.95±74.52 mL for ORN, P=0.036), the length of postoperative stay [6.0 (5.0-9.0) for LRN vs. 9.0 (6.0-11.5) days for ORN, P=0.015], and removal time of the drainage tube [4.0 (3.0-5.0) days for LRN vs. 5.0 (4.0-6.0) for ORN, P<0.001] were less than in the LRN group.The pathological subtype and Fuhrman grade were comparable. Both groups were followed up for a similar period, and no difference was observed in 5-year survival rates.Conclusions: Considering the conversion rates and overall complication rates, it seems that LRN for large renal carcinomas demonstrated equivalent peri-operative safety and effectiveness compared with ORN, with no adverse effects on midterm oncological outcomes.

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Section: Discussionmentioning

confidence: 99%

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

Nian¹,

Ye²,

Zhang³

et al. 2022

Transl Androl Urol

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“…To ensure groups of identical size and cofounders, we performed a 1:1 matched pair analysis, based upon gender, age, ASA, and chronic NRS preoperatively [ 27 ]. If there was more than one possible matching partner, the matching patient was chosen randomly.…”

Section: Methodsmentioning

confidence: 99%

“…A recent study compared the postoperative functional outcome and quality of life of patients receiving primary THA with an ERAS concept and such receiving conventional THA. Patients in the ERAS group reported superior functional results in the WOMAC score 1 year postoperatively [ 27 ]. Nevertheless, literature review reveals inconsistent data availability concerning early postoperative pain [ 17 , 19 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

No clinically significant difference in postoperative pain and side effects comparing conventional and enhanced recovery total hip arthroplasty with early mobilization

Reinhard¹,

Schindler²,

Leiß³

et al. 2023

Arch Orthop Trauma Surg

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Introduction Enhanced recovery after surgery (ERAS) leads to less morbidity, faster recovery, and, therefore, shorter hospital stays. The expected increment of primary total hip arthroplasty (THA) in the U.S. highlights the need for sufficient pain management. The favorable use of short-lasting spinal anesthesia enables early mobilization but may lead to increased opioid consumption the first 24 h (h) postoperatively. Methods In a retrospective study design, we compared conventional THA with postoperative immobilization for two days (non-ERAS) and enhanced recovery THA with early mobilization (ERAS group). Data assessment took place as part of the “Quality Improvement in Postoperative Pain Treatment project” (QUIPS). Initially, 2161 patients were enrolled, resulting in 630 after performing a matched pair analysis for sex, age, ASA score (American-Society-of-Anesthesiology) and preoperative pain score. Patient-reported pain scores, objectified by a numerical rating scale (NRS), opioid consumption and side effects were evaluated 24 h postoperatively. Results The ERAS group revealed higher activity-related pain (p = 0.002), accompanied by significantly higher opioid consumption (p < 0.001). Maximum and minimum pain as well as side effects did not show significant differences (p > 0.05). Conclusion This study is the first to analyze pain scores, opioid consumption, and side effects in a matched pair analyses at this early stage and supports the implementation of an ERAS concept for THA. Taking into consideration the early postoperative mobilization, we were not able to detect a difference regarding postoperative pain. Although opioid consumption appeared to be higher in ERAS group, occurrence of side effects ranged among comparable percentages.

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“…In 2007, the Lancet titled primary THA as the operation of the century [4]. A lot of studies showed good to excellent clinical outcomes after primary THA in the non-geriatric patient [17,18]. To evaluate the functional outcome after THA and the health-related quality of life, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the EQ5D-5L are most widely used.…”

Section: Purposementioning

confidence: 99%

Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial

Reinhard,

Michalk,

Schiegl

et al. 2024

JCM

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Background/Objectives: Osteoarthritis (OA) represents the most frequent chronic joint disease worldwide. Facing an aging population, resulting from the demographic change, the number of primary total hip arthroplasties (THA) will further increase. Although the geriatric patient strongly differs from the younger one, the current literature on elective orthopedic surgery in the geriatric patient is scarce. This work analyses, whether geriatric patients receiving primary THA significantly improve in terms of their (1) mobility and functional outcome and (2) health-related quality of life at four to six weeks as well as three months postoperatively. Methods: In a prospective study design, we analyzed 101 geriatric patients with osteoarthritis of the hip receiving primary THA. The study is part of the ongoing “Special Orthopaedic Geriatrics” (SOG) trial, which is funded by the German Federal Joint Committee (GBA). In addition to a preoperative comprehensive geriatric assessment (CGA), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the EQ5D-5L were imposed preoperatively (t0), at four to six weeks (t1), and at three months (t2) postoperatively. Results: The 101 enrolled patients had a mean age of 78.1 ± 4.9 years. The total WOMAC score and almost all subcategories significantly improved at four to six weeks as well as three months postoperatively in comparison to the preoperative results (p < 0.001). The same was observed for the EQ-5D-5L, showing significant improvement in overall health at both time points (p < 0.001) and all subcategories (p < 0.05). Conclusions: This study implies that a geriatric patient benefits as much from elective primary THA as a younger patient. However, the preoperative comprehensive geriatric assessment with screening for risk factors is of utmost importance. Regarding the aging population, a lot of effort is needed to obtain more knowledge about geriatric patients receiving elective orthopedic surgery.

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Superior Functional Outcome and Comparable Health-Related Quality of Life after Enhanced Recovery vs. Conventional THA: A Retrospective Matched Pair Analysis

Cited by 10 publications

References 18 publications

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

No clinically significant difference in postoperative pain and side effects comparing conventional and enhanced recovery total hip arthroplasty with early mobilization

Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial

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