scholarly journals Can the Blaylock Risk Assessment Screening Score (BRASS) predict length of hospital stay and need for comprehensive discharge planning for patients following hip and knee replacement surgery? Predicting arthroplasty planning and stay using the BRASS

2014 ◽  
Vol 57 (6) ◽  
pp. 391-397 ◽  
Author(s):  
Danny Cunic ◽  
Shawn Lacombe ◽  
Kiarash Mohajer ◽  
Heather Grant ◽  
Gavin Wood
Keyword(s):  
Risk Assessment ◽  
Hospital Stay ◽  
Knee Replacement ◽  
Discharge Planning ◽  
Length Of Hospital Stay ◽  
Knee Replacement Surgery ◽  
Replacement Surgery

scholarly journals Fast track surgery for knee replacement surgery: a lean six sigma approach

2020 ◽  
Vol 32 (3) ◽  
pp. 461-474 ◽  
Author(s):  
Carlo Ricciardi ◽  
Giovanni Balato ◽  
Maria Romano ◽  
Ida Santalucia ◽  
Mario Cesarelli ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Knee Replacement ◽  
Six Sigma ◽  
Fast Track ◽  
Length Of Hospital Stay ◽  
Lean Six Sigma ◽  
Fast Track Surgery ◽  
Content Type ◽  
Knee Replacement Surgery ◽  
Replacement Surgery

Purpose The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues. Design/methodology/approach Lean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems. Findings The corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified. Research limitations/implications The follow up and the satisfaction of patients were not analyzed and could be a future development of this study. Practical implications Patients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management. Originality/value The introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.

Comparison between ropivacaine local infiltration analgesia with ketorolac or placebo for total knee replacement surgery

2012 ◽  
Vol 3 (3) ◽  
pp. 196-197
Author(s):  
K.V. Andersen ◽  
L. Nikolajsen ◽  
V. Haraldsted ◽  
N.T. Andersen ◽  
C.F. Jepsen ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Length Of Hospital Stay ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Total Knee ◽  
Infiltration Analgesia

AbstractBackground/aimsOptimal pain treatment with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee replacement surgery. Local infiltration analgesia (LIA) with local anaesthetic might be effective and adjuncts such as ketorolac may provide additional effects on opioid requirements and pain. We tested the hypothesis that adding ketorolac significantly improves analgesia after total knee replacement surgery.MethodsSixty patients were enrolled in this prospective double-blinded study and allocated to either group R (placebo) or Group RK (ketorolac 120 mg). All patients received high-volume LIA with 150 ml ropivacaine (300 mg) with epinephrine added either placebo or ketorolac (30 mg) combined with eight 10 ml ropivacaine doses (100 mg) added either placebo or ketorolac (15 mg) administered every 6 h through an intra-articular catheter for 48 h. postoperatively. The primary outcome was patient-controlled morphine consumption from 0–6 and 0–48 h after surgery. Time to first rescue administration, pain intensity (0–100 mm visual analogue scale) at rest and during mobilization and side-effects were recorded until 96 h after surgery.ResultsSix and forty-eight morphine consumption was significantly reduced in group RK compared with group R. Time to first rescue analgesia was significantly prolonged with 4 h in group RK [median (IQR)] 490 min (248–617) compared with 223 min (115–319) group R (P < 0.02). Pain at rest and during movement was significantly reduced for 48 h with the addition of ketorolac. Length of hospital stay was reduced with one day in group RK [median (IQR)] 2 days (2–3) compared with group R3 days (2–3) (P =0.004).ConclusionsKetorolac resulted in a 75% reduction in 48 h postoperative morphine requirements. This was also significantly associated with prolonged analgesia, reduced pain intensity scores at rest and during movement and reduced length of hospital stay.

Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2)

2014 ◽  
Vol 120 (4) ◽  
pp. 852-860 ◽  
Author(s):  
Cynthia So-Osman ◽  
Rob G. H. H. Nelissen ◽  
Ankie W. M. M. Koopman-van Gemert ◽  
Ewoud Kluyver ◽  
Ruud G. Pöll ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Control Group ◽  
Transfusion Rate ◽  
Cell Saver ◽  
Patient Blood Management ◽  
Blood Management ◽  
Knee Replacement Surgery ◽  
Total Hip ◽  
Replacement Surgery ◽  
Preoperative Hemoglobin

Abstract Background: Patient blood management is introduced as a new concept that involves the combined use of transfusion alternatives. In elective adult total hip- or knee-replacement surgery patients, the authors conducted a large randomized study on the integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices (DRAIN) to evaluate allogeneic erythrocyte use, while applying a restrictive transfusion threshold. Patients with a preoperative hemoglobin level greater than 13 g/dl were ineligible for erythropoietin and evaluated for the effect of autologous blood reinfusion. Methods: Patients were randomized between autologous reinfusion by cell saver or DRAIN or no blood salvage device. Primary outcomes were mean intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness. Results: In 1,759 evaluated total hip- and knee-replacement surgery patients, the mean erythrocyte use was 0.19 (SD, 0.9) erythrocyte units/patient in the autologous group (n = 1,061) and 0.22 (0.9) erythrocyte units/patient in the control group (n = 698) (P = 0.64). The transfusion rate was 7.7% in the autologous group compared with 8.3% in the control group (P = 0.19). No difference in erythrocyte use was found between cell saver and DRAIN groups. Costs were increased by €298 per patient (95% CI, 76 to 520). Conclusion: In patients with preoperative hemoglobin levels greater than 13 g/dl, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives: use of these devices did not reduce erythrocyte use and increased costs.

scholarly journals How safe is primary knee replacement surgery? Perioperative complication rates in Northern Illinois, 1993-1999

2004 ◽  
Vol 51 (1) ◽  
pp. 110-116 ◽  
Author(s):  
Joe Feinglass ◽  
Hagay Amir ◽  
Patricia Taylor ◽  
Ithai Lurie ◽  
Larry M. Manheim ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Complication Rates ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Perioperative Complication
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