Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort s
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(2020) 21:721
RESEARCH ARTICLE
Open Access
Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study Ulla Plenge1* , Romy Parker1, Shamiela Davids2, Gareth L. Davies3, Zahnne Fullerton4, Lindsay Gray5, Penelope Groenewald6, Refqah Isaacs7, Ntambue Kauta8, Frederik M. Louw9, Andile Mazibuko10, David M. North11, Marc Nortje12, Glen M. Nunes13, Neo Pebane14, Chantal Rajah15, John Roos16, Paul Ryan17, Winlecia V. September18, Heidi Shanahan19, Ruth E. Siebritz20, Rian W. Smit21, Simon Sombili22, Alexandra Torborg23, Johan F. van der Merwe24, Nico van der Westhuizen25 and Bruce Biccard1
Abstract Background: Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice. Methods: From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice. Results: Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%). (Continued on next page)
* Correspondence: [email protected] 1 Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape 7925, South Africa Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate
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