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Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.
Subject(s)
Humans , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Early Ambulation , Postoperative Complications/etiology , Hemoglobins , Prospective Studies , Length of StayABSTRACT
BACKGROUND: Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. METHODS: This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. RESULTS: A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24.áhours [16.Çô30]. 4,222 (69.3%) patients moved in .ëñ 24.áhours after surgery. Local anesthesia [OR.á=.á0.80 (95% confidence interval [CI]: 0.72.Çô0.90); p.á=.á0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55.Çô0.60); p.á<.á0.001], mean adherence to ERAS items [OR.á=.á0.93 (95% CI: 0.92.Çô0.93); p.á<.á0.001], and preoperative hemoglobin [OR.á=.á0.97 (95% CI: 0.96.Çô0.98); p.á<.á0.001] were associated with shorter time to mobilization. CONCLUSIONS: Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Early Ambulation , Humans , Hemoglobins , Length of Stay , Postoperative Complications/etiology , Prospective StudiesABSTRACT
BACKGROUND: In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS® Protocol for thoracic surgery patients (PROSM). METHODS: Patients' data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients' data were organized for analysis after the institution's ethics committee gave their approval. Patients' variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission. RESULTS: PROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group. CONCLUSIONS: This study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols.
ABSTRACT
Introducción: El concepto de protocolos de recuperación rápida o precoz fue insertado en la práctica clínica por Henrik Kehlet en 1997, con el objetivo de mejorar la calidad en los cuidados perioperatorios y disminuir la morbilidad y mortalidad. Objetivo: Determinar que la implementación de los protocolos en cirugía cardiaca ya no constituye una utopía. Métodos: La búsqueda bibliográfica estuvo constituida por todos los artículos publicados que evaluaron la utilidad de los protocolos de recuperación rápida o precoz. Desarrollo: Los protocolos de recuperación precoz han sido desarrollados durante décadas y abarcan un conjunto de acciones que cubren todo el periodo perioperatorio. Para lograr la completa adherencia se necesita de un equipo multidisciplinario. Su implementación comenzó en la cirugía colorectal y fueron gradualmente expandidos y adaptados a casi todas la especialidades quirúrgicas. En la cirugía cardiaca por razones no específicas, que incluyen el uso de la circulación extracorpórea, la implementación ha sido demorada pero la evidencia científica existente, aunque no es suficiente, muestra que la adherencia a estos influye de manera positiva en la recuperación de los enfermos, por lo que surge la necesidad de estandarizarlos. Conclusiones: La implementación de estos protocolos en la cardiocirugía ya es una realidad. En abril de 2017 se constituyó la sociedad responsable de dicho proceso, cuyo lema es el de optimizar los cuidados perioperatorios a través de un análisis colaborativo, el consenso de expertos y la diseminación de las mejores prácticas(AU)
Introduction: The concept of rapid or early recovery protocols was inserted into clinical practice by Henrik Kehlet in 1997, with the aim of improving the quality of perioperative care and decreasing morbidity and mortality. Objective: To determine that the implementation of protocols in heart surgery is no longer a utopia. Methods: The bibliographic search was made up of all the published articles that evaluated the usefulness of the rapid or early recovery protocols. Development: Early recovery protocols have been developed for decades and comprise a set of actions that cover the entire perioperative period. A multidisciplinary team is needed to achieve complete adherence. Its implementation began in colorectal surgery and it was gradually expanded and adapted to almost all surgical specialties. In heart surgery for non-specific reasons, including the use of extracorporeal circulation, the implementation has been delayed but the existing scientific evidence, although not enough, shows that adherence to these protocols influences positively the recovery of patients; so, the need to standardize them has arisen. Conclusions: The implementation of these protocols in heart surgery is now a reality. In April 2017, the company responsible for this process was created, whose motto is to optimize perioperative care through a collaborative analysis, consensus of experts and the dissemination of best practices(AU)