To investigate the impact of consecutive perioperative care transitions on in-hospital recovery of patients who had primary total knee arthroplasty (TKA) over an 11-year period. This observational cohort study used electronic health record data from all patients undergoing preoperative screening for primary TKA at a Northern Netherlands hospital between 2009 and 2020. In this timeframe, three perioperative care transitions were divided into four periods: Baseline care (Joint Care, n = 171; May 2009 to August 2010), Function-tailored (n = 404; September 2010 to October 2013), Fast-track (n = 721; November 2013 to May 2018), and Prehabilitation (n = 601; June 2018 to December 2020). In-hospital recovery was measured using inpatient recovery of activities (IROA), length of stay (LOS), and discharge to preoperative living situation (PLS). Multivariable regression models were used to analyze the impact of each perioperative care transition on in-hospital recovery.Aims
Methods
To investigate whether pre-operative functional mobility is a
determinant of delayed inpatient recovery of activities (IRoA) after
total knee arthroplasty (TKA) in three periods that coincided with
changes in the clinical pathway. All patients (n = 682, 73% women, mean age 70 years, standard
deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively
screened for functional mobility by the Timed-up-and-Go test (TUG)
and De Morton mobility index (DEMMI). The cut-off point for delayed
IRoA was set on the day that 70% of the patients were recovered,
according to the Modified Iowa Levels of Assistance Scale (mILAS)
(a 5-item activity scale). In a multivariable logistic regression
analysis, we added either the TUG or the DEMMI to a reference model
including established determinants.Aims
Patients and Methods
The goal of this study was to describe and evaluate the implementation of a tailored care pathway as an alternative to a standard joint care protocol in the postoperative in-hospital rehabilitation after total knee replacement (TKR) on clinically relevant outcome parameters. We monitored an orthopaedic department regarding postoperative rehabilitation after TKR on several outcome parameters throughout a period of 32 months, whilst introducing a new care pathway after 17 months. Outcome parameters were monitored and comprised: Time to get functionally recovered (in days), length of stay (in days) and destination of discharge. Key-differences between the joint care protocol and the new tailored pathway were: 1. determination of individual short term rehabilitation goals on the basis of a preoperative clinical prediction rule and postoperative monitoring of functional recovery, 2. Enhancement of expertise of and collaboration between health care professionals and 3. implementation of fast track rehabilitation. We compared the patients operated after implementation of the tailored care pathway with those who were treated according to the joint care protocol. Regression analysis was used to estimate differences between the two groups of patients while correcting for baseline differences in risk profile between the groups.Objectives
Methods
