Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

BACKGROUND The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. OBJECTIVE The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. METHODS A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. CONCLUSIONS Digital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.

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Computer assisted versus conventional total knee replacement: A comparison of tourniquet time, blood loss and length of stay

The Knee ◽

10.1016/j.knee.2011.11.006 ◽

2012 ◽

Vol 19 (5) ◽

pp. 606-610 ◽

Cited By ~ 16

Author(s):

Sanil H. Ajwani ◽

Morgan Jones ◽

Jeremy W. Jarratt ◽

Gordon J. Shepard ◽

William G. Ryan

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Total Knee Replacement ◽

Knee Replacement ◽

Computer Assisted ◽

Tourniquet Time ◽

Total Knee

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Enhanced recovery programmes can reduce length of stay after total knee replacement without sacrificing functional outcome at one year

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.0016 ◽

2015 ◽

Vol 97 (8) ◽

pp. 563-567 ◽

Cited By ~ 13

Author(s):

JF Maempel ◽

PJ Walmsley

Keyword(s):

Length Of Stay ◽

Total Knee Replacement ◽

Range Of Motion ◽

Functional Outcome ◽

Knee Replacement ◽

Enhanced Recovery ◽

District General Hospital ◽

Significant Difference ◽

Total Knee ◽

One Year

Introduction Enhanced recovery programmes (ERPs) are being widely adopted in total knee replacement (TKR) procedures but studies confirming that they have no adverse effects on functional outcomes are lacking. The aim of this study was to compare length of stay, postoperative functional outcome and range of motion at one year postoperatively between patients undergoing TKR with an ERP and those with traditional rehabilitation. Methods A total of 165 consecutive patients undergoing primary unilateral TKR were included in the study. Overall, 84 patients undergoing TKR with an ERP were compared with a series of 81 patients undergoing primary unilateral TKR with traditional rehabilitation, immediately before the introduction of the ERP. Results The median postoperative length of stay was 3 days in the ERP cohort and 4 in the traditionally rehabilitated cohort (p<0.001). There were no significant differences in the preintervention characteristics of the groups and there was no significant difference in operative time, transfusion or rates of manipulation under anaesthesia. There was no difference in magnitude of improvement in American Knee Society score (p=0.12) or range of motion (p=0.81) between the groups. Conclusions ERP can reduce length of stay after TKR while offering improvements in knee function equivalent to those experienced by patients undergoing TKR with traditional rehabilitation. Furthermore, ERP can be implemented successfully in the setting of a district general hospital.

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The effect of early mobility in patients after Total Knee Replacement on hospital length of stay, pain and function: A randomised control trial

Physiotherapy Practice and Research ◽

10.3233/ppr-170093 ◽

2017 ◽

Vol 38 (2) ◽

pp. 121-125

Author(s):

Sathiyapriya Gnanakumaran ◽

Frank Li ◽

Megan White ◽

Natalie Shiel ◽

Peter Walker ◽

...

Keyword(s):

Length Of Stay ◽

Total Knee Replacement ◽

Knee Replacement ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Randomised Control Trial ◽

Early Mobility ◽

Total Knee ◽

And Function

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Total Hip Replacement and Total Knee Replacement outcomes in the elderly - An opportunity for further improvement of ERAS pathways.

10.14293/s2199-1006.1.sor-.ppq8hwz.v1 ◽

2020 ◽

Author(s):

Louise Burgess ◽

Thomas Wainwright

Keyword(s):

Length Of Stay ◽

Total Knee Replacement ◽

Elderly Patients ◽

Total Hip Replacement ◽

Knee Replacement ◽

Hip Replacement ◽

Enhanced Recovery ◽

The Elderly ◽

Very Elderly ◽

Total Knee

Introduction Postoperative outcomes of total hip replacement (THR) and total knee replacement (TKR) have been improved by Enhanced Recovery after Surgery (ERAS) guidelines. The elderly population is increasing and successful fast-track rehabilitation can be achieved amongst this cohort. However, the cohorts studied in previous literature are generally younger, healthy patients, who would be expected to recover well from a multidisciplinary pathway. Literature to assess the role of enhanced recovery in the very elderly is limited. The aim of this study is to assess the current outcomes for elderly patients post THR and TKR and explore the opportunity for further application of ERAS pathways. Methods This retrospective study was completed by collecting UK acute NHS hospital data through Hospital Episode Statistics (HES), accessed via the Dr. Foster Healthcare Intelligence Portal. Length of stay, readmission rates, complication of care and mortality were recorded for all THR and TKR cases. Results Length of stay, readmission and complication of care rates increased linearly with age for both THR and TKR patients. For over 85s, average length of stay was 5.0 and 4.5 days (THR and TKR respectively), 30 day re-admission was 9.4% and 9.9%, complication of care was 13.3% and 11.9% and mortality rate was 0.5% and 0.4%. Conclusions The very elderly have the most to gain from an ERAS programme but still have the longest stay in hospital and the greatest post-operative complications. Further work is required to determine how to reduce the risk of complications and increase functional recovery in elderly patients.

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