Abstract
BackgroundThe introduction of enhanced recovery pathways has demonstrated both patient and organisational benefits. However, enhanced recovery pathways implemented for total hip arthroplasty (THA) and total knee arthroplasty (TKA) vary between health-care organisations, as do their measures of success, particularly patient-related outcomes. Despite inpatient functional recovery being essential for safe and timely hospital discharge, there is currently no gold standard method for its assessment, and the research undertaken to establish prognostic factors is limited. This study aimed to identify prognostic factors and subsequently develop prognostic models for inpatient functional recovery following primary, unilateral THA and TKA; identify factors associated with acute length of stay; and assess the relationships between inpatient function and longer-term functional outcomes.MethodsCorrelation and multiple regression analyses were used to determine prognostic factors for functional recovery (assessed using the modified Iowa Level of Assistance Scale on day 2 post-operatively) in a prospective cohort study of 354 patients following primary, unilateral THA or TKA.ResultsFor the overall cohort and TKA group, significant prognostic factors included age, sex, pre-operative general health, pre-operative function, and use of general anaesthesia, local infiltration analgesia, and patient-controlled analgesia. In addition, arthroplasty site was a prognostic factor for the overall cohort, and surgery duration was prognostic for the TKA group. For the THA group, significant prognostic factors included pre-operative function, Risk Assessment and Prediction Tool score, and surgical approach. Several factors were associated with acute hospital length of stay. Inpatient function was positively correlated with functional outcomes assessed at 6 months post-operatively.ConclusionsPrognostic models may facilitate the prediction of inpatient flow thus optimising organisational efficiency. Surgical prognostic factors warrant consideration as potential key elements in enhanced recovery pathways, associated with early post-operative functional recovery. Standardised measures of inpatient function serve to evaluate patient-centred outcomes and facilitate the benchmarking and improvement of enhanced recovery pathways.
Highlights
The introduction of enhanced recovery pathways has demonstrated both patient and organisational benefits
Significant differences existed between total hip arthroplasty (THA) and total knee arthroplasty (TKA) groups for mean body mass index (BMI) (p = 0.002), American Society of Anaesthesiologists (ASA) grade distribution (p < 0.001), patient-reported preoperative function as determined by mean Oxford Hip Score (OHS) or Oxford Knee Score (OKS) scores (p = 0.02), and mean Risk And Prediction Tool (RAPT) score (p = 0.03)
The findings indicate that a range of patient-related factors assessed preoperatively as well as surgical and post-operative factors were associated with inpatient functional outcomes and with length of stay (LOS) following THA and TKA
Summary
The introduction of enhanced recovery pathways has demonstrated both patient and organisational benefits. Enhanced recovery pathways implemented for total hip arthroplasty (THA) and total knee arthroplasty (TKA) vary between health-care organisations, as do their measures of success, patientrelated outcomes. This study aimed to identify prognostic factors and subsequently develop prognostic models for inpatient functional recovery following primary, unilateral THA and TKA; identify factors associated with acute length of stay; and assess the relationships between inpatient function and longer-term functional outcomes. As such, enhanced recovery pathways (ERP) have been applied to several surgical procedures, including THA and TKA, to improve and streamline the delivery of patient care and reduce hospital length of stay (LOS). Every step of the surgical journey, pre-operatively to post-operatively, is examined, rationalised, optimised, and standardised, resulting in a streamlined care pathway combining evidence-based clinical features with optimal organisational efficiency [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
