scholarly journals Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Delirium in Elderly Patients Undergoing Total Hip Arthroplasty

2021 ◽  
Vol 105 (1-3) ◽  
pp. 328-335
Author(s):  
Chen Yan ◽  
Dai Ti-jun
Keyword(s):  
Heart Rate ◽  
Total Hip Arthroplasty ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Postoperative Delirium ◽  
Length Of Hospital Stay ◽  
Anesthesia Induction ◽  
Total Hip ◽  
Group D

Objective To investigate the effects of dexmedetomidine on postoperative delirium in elderly patients undergoing total hip arthroplasty. Methods A total of 100 patients, 42 male and 58 female, ages 60 to 85 years, American Society of Anesthesiologists grade I or II, who were undergoing total hip arthroplasty were randomly divided into 2 groups: a dexmedetomidine group (group D; n = 50) and a control group (group C; n = 50). Group D patients were infused with 0.3 μg · kg−1 · h−1 of dexmedetomidine from 5 minutes prior to anesthesia induction until the end of surgery. Group C patients received an equal volume of saline. Heart rate and mean arterial pressure (MAP) were recorded before anesthesia induction (T0), 1 minute before extubation (T1), and 30 minutes after extubation (T2). The Visual Analog Score (VAS) at 1, 2, and 3 days after surgery, the incidence and duration of postoperative delirium, and the length of hospital stay were recorded. Adverse reactions, such as nausea, vomiting, and lethargy, were also recorded. Results The Visual Analog Scores in the 2 groups were similar. In group D, there was no significant difference in heart rate (P = 0.232) and MAP (P = 0.056) between T0 and T1. However, in group C, heart rate significantly increased by 15.3 bpm (P = 0.000) and MAP significantly increased by 10.7 mmHg (P = 0.001) at T1 compared with those at T0. The incidence of postoperative delirium in group D (10%) was significantly lower than that in group C (26%; P = 0.037). The duration of delirium in group D (1.3 ± 0.6 days) was shorter than that in group C (3.0 ± 0.5 days; P = 0.000). The length of hospital stay in group D (13.2 ± 0.9 days) was shorter than that in group C (16.1 ± 0.7 days; P = 0.000). No significant differences were observed in adverse effects between the 2 groups. Conclusion Intravenous infusion of dexmedetomidine can not only reduce the incidence and duration of postoperative delirium, but also shorten the length of hospital stay in elderly patients undergoing total hip arthroplasty.

scholarly journals Comparative prospective randomized study of minimally invasive transpiriformis approach versus conventional posterolateral approach in total hip arthroplasty as measured by biology markers

2021 ◽  
Author(s):  
Cong Xiao ◽  
Zhixiang Gao ◽  
Shaoyun Zhang ◽  
Nengji Long ◽  
Kai Yao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Controlled Trial ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Total Hip

Abstract Background Minimally invasive surgery is becoming increasingly common, but evidence of the advantages of the minimally invasive transpiriformis approach in total hip arthroplasty is limited. Therefore, our single-centre randomized controlled trial evaluated the benefits of this approach versus the posterolateral approach. Methods Forty-nine patients undergoing the minimally invasive transpiriformis approach and 57 patients undergoing the posterolateral approach total hip arthroplasty were analyzed. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded. In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded. Results Patients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs. 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs. 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Serum levels of CRP, IL-6, MB, CK-MB, and CK were also lower. According to the Harris hip score, the minimally invasive transpiriformis group showed significant improvement at one week and one month after surgery. Conclusion Compared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage.

scholarly journals Identification and Treatment of Anaemia in Patients Awaiting Hip Replacement

2008 ◽  
Vol 90 (6) ◽  
pp. 504-507 ◽  
Author(s):  
BA Rogers ◽  
A Cowie ◽  
C Alcock ◽  
JW Rosson
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Length Of Hospital Stay ◽  
Waiting List ◽  
Transfusion Rate ◽  
Total Hip ◽  
Postoperative Blood Transfusion ◽  
Entire Patient Cohort

INTRODUCTION The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery. PATIENTS AND METHODS From a prospective series of 322 patients undergoing elective total hip arthroplasty (THA), patients identified as anaemic (haemoglobin (Hb) < 12 g/dl) when initially placed upon the waiting list were appropriately investigated and treated. Pre- and postoperative Hb levels, need for transfusion, and length of hospital stay were collated for the entire patient cohort. RESULTS Of the cohort, 8.8% of patients were anaemic when initially placed upon the waiting list for THA and had a higher transfusion rate (23% versus 3%; P < 0.05) and longer hospital stay (7.5 days versus 6.6 days; P < 0.05). Over 40% of these patients responded to investigation and treatment whilst on the waiting list, showing a significant improvement in Hb level (10.1 g/dl to 12.7 g/dl) and improved transfusion rate. CONCLUSIONS Quantifying the haemoglobin level of patients when initially placed on the waiting list helps highlight those at risk of requiring a postoperative blood transfusion. Further, the early identification of anaemia allows for the utilisation of the waiting-list time to investigate and treat these patients. For patients who respond to treatment, there is a significant reduction in the need for blood transfusion with its inherent hazards.

scholarly journals Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

2017 ◽  
Vol 11 (1) ◽  
pp. 1417-1422 ◽  
Author(s):  
Gerasimos Petridis ◽  
Martin Nolde
Keyword(s):  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Harris Hip Score ◽  
Invasive Approach ◽  
Total Hip ◽  
The Mean

Background: Sequential bilateral total hip arthroplasty (THA) has the potential advantages of a single operative intervention with a single hospital stay, alongside reduced costs and total rehabilitation times. Its use has been limited, however, by a theoretical increase in perioperative complications. Objective: The purpose of this study was to assess functional outcomes and complications in patients undergoing sequential bilateral THA performed using anterior minimally invasive surgery (AMIS). We hypothesized that sequential bilateral THA yields favorable clinical outcome and is safe to perform. Methods: Two surgical centres conducted a retrospective observational analysis of 130 patients (77 females) with a mean age of 57 (range, 35-77) years, all of whom were treated by one surgeon and followed up for 24 months. Results: The mean length of hospital stay length was 8.4 (range, 6–18) days. The mean operative time was 162 (range, 92–185) minutes, the mean intraoperative blood loss was 499.1ml, and the mean preoperative and postoperative hemoglobin levels were 14.3 g/dl and 11.3 g/dl, respectively. No perioperative complications or deaths were recorded. The Harris Hip Score (HHS) improved from 44.5 ±13.7 preoperatively to 98.9 ± 1.0 at final follow-up. Also the High Activity Arthroplasty Score (HAAS) and the Questions on Life Satisfaction (FLZ) score improved significantly. Conclusion: This retrospective analysis suggests that, in selected patients, sequential bilateral THA via an anterior minimally invasive approach appears to be a valid alternative to two-stage bilateral THA. Further studies are warranted.

Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty?

2000 ◽  
Vol 15 (4) ◽  
pp. 448-452 ◽  
Author(s):  
Jane H Hayes ◽  
R Cleary ◽  
W.J Gillespie ◽  
I.M Pinder ◽  
J.L Sher
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Length Of Hospital Stay ◽  
Total Hip

Decreasing Length of Hospital Stay and Postoperative Complications After Primary Total Hip Arthroplasty: A Decade Analysis From 2006 to 2016

2019 ◽  
Vol 34 (3) ◽  
pp. 422-425 ◽  
Author(s):  
Matthew J. Grosso ◽  
Alexander L. Neuwirth ◽  
Venkat Boddapati ◽  
Roshan P. Shah ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Length Of Hospital Stay ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Surgical Approaches in Total Hip Arthroplasty Cost Per Case Analysis: A Retrospective, Matched, Micro-costing Analysis in a Socialised Healthcare System

2019 ◽  
Vol 30 (4) ◽  
pp. 391-397 ◽  
Author(s):  
Rajrishi Sharma ◽  
Irafan Abdulla ◽  
Lewis Fairgrieve-Park ◽  
Saboura Mahdavi ◽  
Brian Burkart ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Financial Services ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Surgical Approaches ◽  
Total Hip ◽  
End Stage ◽  
Costing Analysis

Background: Total hip arthroplasty (THA) offers an effective method of pain relief and restoration of function for patients with end-stage arthritis. The anterior approach (AA) claims to benefit patients with decreased pain, increased mobilisation and decreasing length of hospital stay (LOS). In a socialised healthcare platform we questioned whether the AA, compared to posterior (PA) and lateral (LA) approaches, can decrease the cost burden. Methods: Using a retrospective matched cohort study, we matched 69 AA patients to 69 LA and 69 PA patients for age ( p = 0.99), gender ( p = 0.99) and number of pre-surgical risk factors ( p = 0.99). First, we used the Resource Intensity Weights (RIW) using the Health Services agreed on method of calculating cost. Secondly, micro-costing analysis was performed using the financial services data for each patient’s hospital stay. Results: Using the RIW based cost analysis and 2-day reduction (95% CI 1.8–2.4) in LOS, the AA offers an estimated savings per case of $4099 ( p < 0.001) compared to the LA and PA. Using micro-costing analysis, we found a total saving of $1858.00 per case (95% CI 1391–2324) when comparing the AA to the PA and LA. There was a statistically significant cost savings using every category: Net Direct Salary ($901.00, p < 0.001), Net Drug ($8.00, p = 0.003), Patient Supply ($454.00, p = 0.001), Patient Drug ($15.00, p = 0.008), Indirect Cost ($385.00, p < 0.001), Patient Care Administration ($106.00, p < 0.001). Furthermore, the AA saved 142 minutes of in-hospital rehabilitation time. Conclusion: The AA THA provides statistically significant reductions in cost compared to PA and LA while releasing rehabilitation resources.

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