Rykov, K. (Kyrill) (2014) Totale heup- of knieartroplastiek volgens het fast-track protocol. De relatie tussen perioperatieve factoren en opnameduur. thesis, Medicine.
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Abstract
Background and purpose: Approximately 25.000 total hip arthroplasties (THA) and 20.000 total knee arthroplasties (TKA) are performed in The Netherlands each year. To optimize the perioperative process and to decrease the length of stay (LOS), so called fast-track protocols have been developed. To date there are few studies that identified patient characteristics that can influence the LOS in the fast-track setting. In addition to these fast-track protocols, a preoperative ‘Better in – Better out’ (BiBo) screening has been developed, based on a prediction model, for patients who will undergo a THA. The purpose of this screening is to identify patients at risk for an increased LOS and to guide them pre- and postoperatively. The primary purpose of this study was to identify perioperative factors that may influence the LOS in patients who are treated according to the fast-track protocol. Also, this study tried to validate the BiBo-screening for patients who will undergo a THA or TKA. Patients and methods: A total of 913 (555 THA and 358 TKA) patients who were treated according to the fast-track protocol were included in the study. The median LOS was 2 days for both THA and TKA. The mean LOS was 2.4 days after a THA and 3.1 after a TKA. A database with patient characteristics, radiological, perioperative and physiotherapeutic variables was set up. Multivariable logistic regression analysis was used to identify which variables were associated with an increased LOS. The current BiBo-screening was also analyzed using a multivariabele regression analysis. Subsequently, a new prediction model with other preoperative variables was set up to identify factors that influenced the LOS. Results: 71% of the patients after a THA and 57% of the patients after a TKA were discharged within 2 days. Age, body mass index (BMI), postoperative hemoglobin (Hb) level and the need for blood transfusions were all associated with an increased LOS after a THA. The direct anterior approach to the hip, however, resulted in a decreased LOS. After a TKA age, postoperative Hb level and a Charlson comorbidity index of 2 or more were independently associated with an increased LOS. Analysis of the current BiBo-screening for THA showed that age, an increased Timed Up and Go (TUG) test and a Charnley score B or C were associated with an increased LOS. In the new prediction model age, BMI and preoperative Hb level were predictive for an increased LOS. For TKA the screening in the present form only showed age as a predictive variable, whereas in the new prediction model age, gender and a Charnley C score were predictors for an increased LOS. On the other hand a Kellgren & Lawrence (KL) score of 4 was associated with a decreased LOS. Conclusion and interpretation: Age, BMI, postoperative Hb level and the need for blood transfusions are factors that are associated with an increased LOS after a THA. De direct anterior approach to the hip, however, results in a decreased LOS. After a TKA age, postoperative Hb level and a Charlson comorbidity index of 2 or more were predictive for an increased LOS. The current BiBo-screening could not be validated for THA patients could not be validated. In the new prediction model age, BMI and the preoperative Hb level were predictive for an increased LOS. For TKA patients the current BiBo-screening, also, was not valid. Age, gender and a Charnley score C were associated with an increased LOS. However, a KL score of 4 was predictive for a decreased LOS for the high-risk patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Reininga, Dr. I.H.F. and Raaij, Dr. T.M. van and Munsterman, T. and Martini Ziekenhuis Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1716 |
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