Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Abstract

Background:Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA).Study Design:This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format.Results:Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning.Conclusion:This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.

Surgical Technical Evidence Review of Hip Fracture Surgery Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

“…A prospective cohort study of HFS patients “suitable for early discharge” compared the effect of discharge to home rehabilitation versus inpatient rehabilitation. 73 More patients selected for discharge home returned to their preinjury residence and level of independence at 6 weeks. This was not significant at later time points.…”

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…Red flags about a service performance enable local authorities to initiate the QI process to change clinical practice. Details related to a particular QI approach are out of the scope of this review, and we recommend some of the recent relevant literature [206][207][208].…”

Discussion about Application Effect of Orthopedic Rehabilitation Nursing on Patients Receiving Artificial Hip Replacement

“…Thus, they can fully improve their muscle force and enhance joint stability. The occurrence rate of postoperative complication also decreases [11] . In this study, the patients in the observation group received orthopedic rehabilitation nursing.…”

“…After artificial hip replacement, the probability of prosthetic loosening, dislocation, infection or phlebothrombosis is very large, and these will affect patients' joint functional recovery and seriously affect their living quality [2][3 [4] . In order to further promote clinical treatment effect of artificial hip replacement and fully improve patients' prognosis, scientific and appropriate nursing intervention should be conducted for the patients.…”