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Abstract
IntroductionPrevious studies explored the benefits related to early ambulation postoperatively, but few focused on patients with rheumatoid arthritis (RA). We retrospectively evaluated the incidence and predictors of the inability to begin walking on the first postoperative day (POD) after toe arthroplasty for rheumatoid arthritis.MethodsRA patients who underwent toe arthroplasty at one hospital were retrospectively reviewed. A total of 300 patients were included and divided into two groups: possible group (n = 191), who were able to walk on the first POD, and impossible group (n = 109), who were unable to walk on the first POD. Data were analyzed using odds ratios (OR) with 95% confidence intervals (CI) between various patient factors and the impossible group with logistic regression analysis.ResultsThe incidence of postoperative nausea and vomiting before rehabilitation was significantly associated with the infeasibility of walking rehabilitation on the first POD [OR = 2.43, 95% CI 1.22–4.14, P = 0.003]. The number of rescue analgesics administered before rehabilitation and the supplementation of peripheral nerve block was also associated with the infeasibility of walking rehabilitation on the first POD [OR = 1.29, 95% CI 1.04–1.59, P = 0.003; OR = 0.41, 95% CI 0.20–0.79, P = 0.010, respectively].ConclusionThe incidence of postoperative nausea and vomiting and inadequate postoperative pain management hindered early rehabilitation. Adding peripheral nerve block to general anesthesia had an advantage for postoperative rehabilitation after toe arthroplasty for rheumatoid arthritis.
Highlights
Previous studies explored the benefits related to early ambulation postoperatively, but few focused on patients with rheumatoid arthritis (RA)
We categorized the patients into two groups: (i) possible group, including those who were able to walk during rehabilitation on the first postoperative day (POD), and (ii) impossible group, including those who were unable to walk during rehabilitation on the first POD
We considered that patient factors such as physique, age, sex, daily use of corticosteroid, number of biological disease modifying anti-rheumatic drugs (DMARDs), surgical factors, anesthesia factors, and postoperative factors
Summary
Previous studies explored the benefits related to early ambulation postoperatively, but few focused on patients with rheumatoid arthritis (RA). We retrospectively evaluated the incidence and predictors of the inability to begin walking on the first postoperative day (POD) after toe arthroplasty for rheumatoid arthritis. Rehabilitation is beneficial in patients with rheumatoid arthritis (RA) as it shortens hospital stays [1] and reduces infection [2]. Rehabilitation is affected by several factors such as postoperative pain, postoperative nausea and vomiting (PONV), anesthesia methods, types of surgery, and disease severity. RA patients are more likely to have worse preoperative and postoperative pain [5] and longer hospital stays after surgery (1). The purpose of the present study was to investigate predictors of the inability to walk during rehabilitation after rheumatoid toe arthroplasty
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