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Arthroplasty fast-track

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https://www.readbyqxmd.com/read/28537346/does-length-of-stay-influence-how-patients-rate-their-hospitalization-after-total-hip-arthroplasty
#1
Ronald E Delanois, Chukwuweike Gwam, Jaydev B Mistry, Anton Khlopas, Morad Chughtai, Prem Ramkumar, Nicolas Piuzzi, Ryan Berger, Peter M Bonutti, Arthur L Malkani, Michael A Mont
BACKGROUND: The reimbursement for medical services by Medicare and Medicaid (CMS) has recently changed from fee-for-service to quality-based payments. This is being implemented through the use of patient administered surveys, most commonly Press Ganey. With a recent strive for fast-track total hip arthroplasty (THA), it is important to ascertain whether length-of-stay (LOS) in post-THA patients influences the Press Ganey scores and overall hospital ratings. Therefore, we looked at: 1) Which Press Ganey survey factors affect overall hospital rating in patients who have a short (=2) or longer (>2) length of stay; and 2) whether hospital satisfaction is different between patients who have varied lengths of stay...
May 24, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28511195/safety-aspects-of-postanesthesia-care-unit-discharge-without-motor-function-assessment-after-spinal-anesthesia-a-randomized-multicenter-semiblinded-noninferiority-controlled-trial
#2
Eske Kvanner Aasvang, Christoffer Calov Jørgensen, Mogens Berg Laursen, Jacob Madsen, Søren Solgaard, Mogens Krøigaard, Per Kjærsgaard-Andersen, Hans Mandøe, Torben Bæk Hansen, Jørgen Ulrich Nielsen, Niels Krarup, Annette Elisabeth Skøtt, Henrik Kehlet
BACKGROUND: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. METHODS: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken...
June 2017: Anesthesiology
https://www.readbyqxmd.com/read/28477230/a-matched-case-control-comparison-of-hospital-costs-and-outcomes-for-knee-replacement-patients-admitted-postoperatively-to-acute-care-versus-rehabilitation
#3
Brian K Tse, Tessa L Walters, Steven K Howard, T Edward Kim, Stavros G Memtsoudis, Eric C Sun, Alex Kou, Lorrie Graham, Robert King, Edward R Mariano
For select total knee arthroplasty (TKA) patients, we have established an alternative pathway to bypass the acute care surgical ward and directly admit patients from the post-anesthesia care unit to on-campus rehabilitation. We retrospectively examined whether this 'fast track' pathway decreased costs and improved patient outcomes. After reviewing records of consecutive primary unilateral TKA patients over a 15-month period, each patient admitted to rehabilitation was matched with a control admitted to the acute care ward...
May 5, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28331362/anesthesia-for-the-patient-undergoing-total-knee-replacement-current-status-and-future-prospects
#4
REVIEW
Zachary A Turnbull, Dahniel Sastow, Gregory P Giambrone, Tiffany Tedore
Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28290738/increased-risk-of-intraoperative-and-early-postoperative-periprosthetic-femoral-fracture-with-uncemented-stems
#5
Martin Lindberg-Larsen, Christoffer C Jørgensen, Søren Solgaard, Anne G Kjersgaard, Henrik Kehlet
Background and purpose - The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing factors for intraoperative and early postoperative (≤ 90 days) periprosthetic femoral fractures after cemented and uncemented THA. Patients and methods - This was a prospective observational study in 8 Danish high-volume centers from February 2010 to November 2013...
March 14, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28229182/outpatient-unicompartmental-knee-arthroplasty-who-is-afraid-of-outpatient-surgery
#6
Alexander Hoorntje, Koen L M Koenraadt, Margreet G Boevé, Rutger C I van Geenen
PURPOSE: In recent years, duration of hospitalisation after knee arthroplasty has decreased and fast track and outpatient surgery protocols have been developed. Studies have shown that outpatient surgery is feasible, safe, and cost effective. However, the psychological well-being of patients undergoing outpatient surgery has never been described before. The purpose of this study was to investigate how patients experience outpatient surgery for unicompartmental knee arthroplasty (UKA), examining levels of anxiety and depression, satisfaction, and pain...
March 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28211285/can-local-infiltration-analgesia-increase-satisfaction-in-postoperative-short-term-pain-control-in-total-knee-arthroplasty
#7
David Barastegui, I Robert, E Palau, S Haddad, M Reverte-Vinaixa, L Lorente, M Cots
BACKGROUND: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. OBJECTIVES: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. PATIENTS AND METHODS: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28150297/time-course-and-reasons-for-90-day-mortality-in-fast-track-hip-and-knee-arthroplasty
#8
C C Jørgensen, H Kehlet
BACKGROUND: Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. METHODS: Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates...
April 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28145024/psychopharmacologic-treatment-and-blood-transfusion-in-fast-track-total-hip-and-knee-arthroplasty
#9
Silas Hinsch Gylvin, Christoffer Calov Jørgensen, Anders Fink-Jensen, Pär I Johansson, Henrik Kehlet
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance. STUDY DESIGN AND METHODS: Prospective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment...
January 31, 2017: Transfusion
https://www.readbyqxmd.com/read/28126275/time-driven-activity-based-cost-of-fast-track-total-hip-and-knee-arthroplasty
#10
Signe E Andreasen, Henriette B Holm, Mira Jørgensen, Kirill Gromov, Per Kjærsgaard-Andersen, Henrik Husted
BACKGROUND: Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare this between 2 departments with different logistical set-ups...
December 29, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28079428/the-first-6-weeks-of-recovery-after-primary-total-hip-arthroplasty-with-fast-track
#11
Lisette C M Klapwijk, Nina M C Mathijssen, Jeroen C Van Egmond, Bianca M Verbeek, Stephan B W Vehmeijer
Background and purpose - Fast-track protocols have been introduced worldwide to improve the recovery after total hip arthroplasty (THA). These protocols have reduced the length of hospital stay (LOS), and THA in an outpatient setting is also feasible. However, less is known regarding the first weeks after THA with fast track. We examined patients' experiences of the first 6 weeks after hospital discharge following inpatient and outpatient THA with fast track. Patients and methods - In a prospective cohort study, 100 consecutive patients who underwent THA surgery in a fast-track setting between February 2015 and October 2015 received a diary for 6 weeks...
April 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28073671/fast-track-recovery-technique-applied-to-primary-total-hip-and-knee-replacement-surgery-analysis-of-costs-and-complications
#12
C Wilches, J D Sulbarán, J E Fernández, J M Gisbert, J M Bausili, X Pelfort
PURPOSE: To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. MATERIAL AND METHODS: Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery...
January 7, 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/27922457/daily-physical-activity-in-total-hip-arthroplasty-patients-undergoing-different-surgical-approaches-a-cohort-study
#13
Monika Engdal, Olav A Foss, Kristin Taraldsen, Vigdis S Husby, Siri B Winther
OBJECTIVE: Muscle weakness due to trauma from the surgical approach is anticipated to affect the ability of the patient to undertake daily physical activity early after total hip arthroplasty (THA). The objective of this study was to compare daily physical activity on days 1 to 4 after discharge, in patients following THA performed by 1 of 3 surgical approaches. DESIGN: A cohort study included 60 hip osteoarthritis patients, scheduled for THA, allocated to direct lateral approach, posterior approach, or anterior approach...
December 2, 2016: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/27903009/temperature-controlled-continuous-cold-flow-device-after-total-knee-arthroplasty-a-randomized-controlled-trial-study
#14
Alberto Ruffilli, Francesco Castagnini, Francesco Traina, Isabella Corneti, Domenico Fenga, Sandro Giannini, Cesare Faldini
Total knee arthroplasty (TKA) is a widely accepted and successful procedure for end-stage arthritis. Nevertheless, fast-track may be compromised by many factors, such as pain, edema, and blood loss. Cryotherapy has been advocated as a safe and effective strategy to improve the postoperative results, acting on pain, edema, and blood loss. This study is a prospective randomized controlled study, involving 50 patients after primary TKA. A power analysis was performed preoperatively. Twenty-four patients were addressed to a postoperative treatment with a continuous cold flow device (Hilotherm, Hilotherm GmbH, Germany)...
November 30, 2016: Journal of Knee Surgery
https://www.readbyqxmd.com/read/27822310/anaphylactic-shock-during-cement-implantation-of-a-total-hip-arthroplasty-in-a-patient-with-underlying-mastocytosis-case-report-of-a-rare-intraoperative-complication
#15
Anita Ten Hagen, Pieter Doldersum, Tom van Raaij
BACKGROUND: Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE). CASE PRESENTATION: We describe the rare case of a 70-year old patient who underwent an elective total hip replacement. Before surgery he was diagnosed with underlying systemic indolent mastocytosis, a rare pathological disorder that may result in anaphylaxis after massive systemic mast cell activation...
2016: Patient Safety in Surgery
https://www.readbyqxmd.com/read/27791240/feasibility-of-day-case-total-hip-arthroplasty-a-single-centre-observational-study
#16
Jens Rolighed Larsen, Birgitte Skovgaard, Thomas Prynø, Laimonas Bendikas, Lone R Mikkelsen, Malene Laursen, Mette T Høybye, Søren Mikkelsen, Lene Bastrup Jørgensen
INTRODUCTION: Recent reports indicate that total hip arthroplasty (THA) can be further accelerated and might be managed as day-case. This could provide benefits to health care expenditure, lower patient risks and change patient satisfaction. We evaluated the feasibility, efficacy, safety and patient satisfaction of same-day (<12 hours) THA operation and discharge. METHODS: Consecutive patients were screened for eligibility (primary THA, ASA 1 or 2 physical status) and the presence of a support person to follow the patient for 48 hours postoperatively in an observational study...
October 24, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/27776372/early-removal-of-drainage-tube-after-fast-track-primary-total-knee-arthroplasty
#17
Shaoyun Zhang, Bin Xu, Qiang Huang, Huan Yao, Jinwei Xie, Fuxing Pei
There is no consensus as to whether drainage tube should be used and how long it should remain in use after primary total knee arthroplasty (TKA). As fast-track (FT) program has been implemented in TKA, whether drainage tube could be removed early, and the ideal timing for removal after FT primary TKA has been a new topic. The purpose of this prospective cohort study was to evaluate the safety and feasibility of early removal of drainage tube when FT program was implemented in primary TKA. A total of 101 patients undergoing FT primary TKA were prospectively allocated into three groups...
October 24, 2016: Journal of Knee Surgery
https://www.readbyqxmd.com/read/27759465/thromboembolic-and-major-bleeding-events-in-relation-to-perioperative-bridging-of-vitamin-k-antagonists-in-649-fast-track-total-hip-and-knee-arthroplasties
#18
Christoffer C Jørgensen, Henrik Kehlet
Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies. Patients and methods - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment...
February 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/27660489/relationship-between-self-reported-pain-sensitivity-and-pain-after-total-knee-arthroplasty-a-prospective-study-of-71-patients-8-weeks-after-a-standardized-fast-track-program
#19
Berit T Valeberg, Lise H Høvik, Kari H Gjeilo
BACKGROUND AND PURPOSE: This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. METHODS: The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1-2 weeks prior to surgery)...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27658640/24%C3%A2-hours-stay-after-hip-replacement
#20
Yannick N T Van Den Eeden, Bruno J G De Turck, Frank M C Van Den Eeden
Background and purpose - The length of stay after total hip arthroplasty has been reduced to 2-4 days after implementing fast-track surgery. We investigated whether a new time-based patient-centered primary direct anterior approach (DAA) total hip arthroplasty (THA) treatment protocol in a specialized clinic, with a planned length of stay of about 24 hours, could be achieved in all patients or only in a selected group of patients. Patients and methods - We analyzed prospectively collected data in a cohort of 378 consecutive patients who underwent a primary direct anterior THA as a patient-centered time-based procedure between March 1, 2012 and December 31, 2015...
February 2017: Acta Orthopaedica
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