A stepwise transformation: description and outcome of perioperative procedures in patients receiving a total knee arthroplasty.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2024-06-01 DOI:10.1302/0301-620X.106B6.BJJ-2023-0819.R2

Wim F C van Houtert, Daniël O Strijbos, Richard Bimmel, Wim P Krijnen, Jelmer Jager, Nico L U van Meeteren, Geert van der Sluis

{"title":"A stepwise transformation: description and outcome of perioperative procedures in patients receiving a total knee arthroplasty.","authors":"Wim F C van Houtert, Daniël O Strijbos, Richard Bimmel, Wim P Krijnen, Jelmer Jager, Nico L U van Meeteren, Geert van der Sluis","doi":"10.1302/0301-620X.106B6.BJJ-2023-0819.R2","DOIUrl":null,"url":null,"abstract":"Aims: To investigate the impact of consecutive perioperative care transitions on in-hospital recovery of patients who had primary total knee arthroplasty (TKA) over an 11-year period.Methods: This observational cohort study used electronic health record data from all patients undergoing preoperative screening for primary TKA at a Northern Netherlands hospital between 2009 and 2020. In this timeframe, three perioperative care transitions were divided into four periods: Baseline care (Joint Care, n = 171; May 2009 to August 2010), Function-tailored (n = 404; September 2010 to October 2013), Fast-track (n = 721; November 2013 to May 2018), and Prehabilitation (n = 601; June 2018 to December 2020). In-hospital recovery was measured using inpatient recovery of activities (IROA), length of stay (LOS), and discharge to preoperative living situation (PLS). Multivariable regression models were used to analyze the impact of each perioperative care transition on in-hospital recovery.Results: The four periods analyzed involved 1,853 patients (65.9% female (1,221/1,853); mean age 70.1 years (SD 9.0)). IROA improved significantly with each transition: Function-tailored (0.9 days; p < 0.001 (95% confidence interval (CI) -0.32 to -0.15)), Fast-track (0.6 days; p < 0.001 (95% CI -0.25 to -0.16)), and Prehabilitation (0.4 days; p < 0.001 (95% CI -0.18 to -0.10)). LOS decreased significantly in Function-tailored (1.1 days; p = 0.001 (95% CI -0.30 to -0.06)), Fast-track (0.6 days; p < 0.001 (95% CI -0.21 to -0.05)), and Prehabilitation (0.6 days; p < 0.001 (95%CI -0.27 to -0.11)). Discharge to PLS increased in Function-tailored (77%), Fast-track (91.6%), and Prehabilitation (92.6%). Post-hoc analysis indicated a significant increase after the transition to the Fast-track period (p < 0.001 (95% CI 3.19 to 8.00)).Conclusion: This study highlights the positive impact of different perioperative care procedures on in-hospital recovery of patients undergoing primary TKA. Assessing functional recovery, LOS, and discharge towards PLS consistently, provides hospitals with valuable insights into postoperative recovery. This can potentially aid planning and identifying areas for targeted improvements to optimize patient outcomes.","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.106B6.BJJ-2023-0819.R2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Aims: To investigate the impact of consecutive perioperative care transitions on in-hospital recovery of patients who had primary total knee arthroplasty (TKA) over an 11-year period.

Methods: This observational cohort study used electronic health record data from all patients undergoing preoperative screening for primary TKA at a Northern Netherlands hospital between 2009 and 2020. In this timeframe, three perioperative care transitions were divided into four periods: Baseline care (Joint Care, n = 171; May 2009 to August 2010), Function-tailored (n = 404; September 2010 to October 2013), Fast-track (n = 721; November 2013 to May 2018), and Prehabilitation (n = 601; June 2018 to December 2020). In-hospital recovery was measured using inpatient recovery of activities (IROA), length of stay (LOS), and discharge to preoperative living situation (PLS). Multivariable regression models were used to analyze the impact of each perioperative care transition on in-hospital recovery.

Results: The four periods analyzed involved 1,853 patients (65.9% female (1,221/1,853); mean age 70.1 years (SD 9.0)). IROA improved significantly with each transition: Function-tailored (0.9 days; p < 0.001 (95% confidence interval (CI) -0.32 to -0.15)), Fast-track (0.6 days; p < 0.001 (95% CI -0.25 to -0.16)), and Prehabilitation (0.4 days; p < 0.001 (95% CI -0.18 to -0.10)). LOS decreased significantly in Function-tailored (1.1 days; p = 0.001 (95% CI -0.30 to -0.06)), Fast-track (0.6 days; p < 0.001 (95% CI -0.21 to -0.05)), and Prehabilitation (0.6 days; p < 0.001 (95%CI -0.27 to -0.11)). Discharge to PLS increased in Function-tailored (77%), Fast-track (91.6%), and Prehabilitation (92.6%). Post-hoc analysis indicated a significant increase after the transition to the Fast-track period (p < 0.001 (95% CI 3.19 to 8.00)).

Conclusion: This study highlights the positive impact of different perioperative care procedures on in-hospital recovery of patients undergoing primary TKA. Assessing functional recovery, LOS, and discharge towards PLS consistently, provides hospitals with valuable insights into postoperative recovery. This can potentially aid planning and identifying areas for targeted improvements to optimize patient outcomes.

查看原文本刊更多论文

逐步转变：全膝关节置换术患者围手术期的描述和结果。

目的：研究11年间连续围手术期护理转变对初级全膝关节置换术（TKA）患者院内康复的影响：这项观察性队列研究使用了 2009 年至 2020 年间荷兰北部一家医院所有接受初级全膝关节置换术术前筛查的患者的电子健康记录数据。在此期间，三次围手术期护理转换被分为四个时期：基线护理（关节护理，n = 171；2009 年 5 月至 2010 年 8 月）、功能定制（n = 404；2010 年 9 月至 2013 年 10 月）、快速通道（n = 721；2013 年 11 月至 2018 年 5 月）和预康复（n = 601；2018 年 6 月至 2020 年 12 月）。院内康复采用住院患者活动恢复（IROA）、住院时间（LOS）和出院至术前生活状况（PLS）进行衡量。采用多变量回归模型分析了每种围手术期护理转变对院内康复的影响：分析的四个阶段涉及 1853 名患者（65.9% 为女性（1221/1853）；平均年龄 70.1 岁（SD 9.0））。每次转变后，IROA 都有明显改善：功能定制（0.9 天；p < 0.001（95% 置信区间 (CI) -0.32 至 -0.15））、快速通道（0.6 天；p < 0.001（95% CI -0.25 至 -0.16））和预康复（0.4 天；p < 0.001（95% CI -0.18 至 -0.10））。功能定制（1.1 天；p = 0.001 (95% CI -0.30 to -0.06)）、快速通道（0.6 天；p < 0.001 (95% CI -0.21 to -0.05)）和预康复（0.6 天；p < 0.001 (95%CI -0.27 to -0.11)）的出院时间明显缩短。在功能定制（77%）、快速通道（91.6%）和康复前（92.6%）中，出院至 PLS 的时间有所增加。事后分析表明，在过渡到快速通道阶段后，出院率明显提高（p < 0.001 (95% CI 3.19 to 8.00)）：本研究强调了不同围手术期护理程序对接受初级TKA手术患者院内恢复的积极影响。持续评估功能恢复、LOS 和出院后 PLS，可为医院提供有关术后恢复的宝贵见解。这可能有助于规划和确定需要有针对性改进的领域，从而优化患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

期刊介绍： We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.