Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up
Open Access
- 28 April 2008
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Musculoskeletal Disorders
- Vol. 9 (1), 59
- https://doi.org/10.1186/1471-2474-9-59
Abstract
In Denmark, approximately 12,000 hip and knee arthroplasties were performed in 2006, and the hospital costs were close to US$ 110,000,000. In a randomized clinical trial, we have recently demonstrated the efficacy of accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty compared to current intervention under ideal circumstances. We do not, however, know whether these results could be reached under usual circumstances of healthcare practice. We therefore investigated whether length of stay after implementation of accelerated perioperative care and rehabilitation after hip and knee arthroplasty could be reduced in a normal healthcare setting, and how the achieved results matched those observed during the randomized clinical trial. An effectiveness study as a before-after trial was undertaken in which all elective primary total hip and total knee arthroplasty patients were divided into a before-implementation group receiving the current perioperative procedure, and an after-implementation group receiving the new accelerated perioperative care and rehabilitation procedures as provided by a new multi-disciplinary organization. We used the Breakthrough Series Collaborative Model for implementation. The primary outcome measure was in hospital length of stay (LOS), and the secondary outcome measure was adverse effects within 3 months postoperatively. We included a total of 247 patients. Mean LOS was significantly (P < 0.001) reduced by 4.4 (95% CI 3.8–5.0) days after implementation of the accelerated intervention, from 8.8 (SD 3.0) days before implementation to 4.3 (SD 1.8) days after implementation. No significant differences in adverse effects were observed. LOS in this effectiveness study was significantly lower than LOS reported in the efficacy study. Accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty was successfully and effectively implemented. Results obtained during usual hospital circumstances matched the results achieved under ideal circumstances in this group of patients.This publication has 25 references indexed in Scilit:
- Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: A randomized clinical trial involving 87 patients with 3 months of follow-upActa Orthopaedica, 2008
- Success of Clinical Pathways for Total Joint Arthroplasty in a Community HospitalClinical Orthopaedics and Related Research, 2007
- “To whom do the results of this trial apply?”: External validity of a randomized controlled trial involving 130 patients scheduled for primary total hip replacementActa Orthopaedica, 2007
- Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trialActa Anaesthesiologica Scandinavica, 2006
- Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty—a randomised controlled trialThe Knee, 2005
- Joint Recovery Programme Versus Usual CareMedical Care, 2005
- Fast-track surgeryBritish Journal of Surgery, 2005
- Total hip arthroplasty in DenmarkActa Orthopaedica, 2005
- Effectiveness of clinical pathways for total knee and total hip arthroplastyLiterature reviewThe Journal of Arthroplasty, 2003
- Recent advances: Management of patients in fast track surgeryBMJ, 2001