A DUTCH EXAMPLE OF TRANSITION OF PERIOPERATIVE CARE IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT SURGERY

G. Van Der Sluis¹, W. van Houtert², R. Bimmel³, N. van Meeteren⁴

¹Nij Smellinghe Hospital, Health innovation, Drachten, Netherlands, ²Nij Smellinghe Hospital, Physiotherapy, Drachten, Netherlands, ³Nij Smellinghe Hospital, Orthopics, Drachten, Netherlands, ⁴Erasmus University, Anesthesiology, Rotterdam, Netherlands

Background: In this cohort study we evaluated the effects of 11 years of transition in perioperative patient care regarding Total Knee Replacement (TKR) surgery at the orthopedic ward of a regional hospital in the northern part of the Netherlands.

Purpose: To improve patient outcomes, especially inpatient recovery of activities (IROA), we developed, implemented and evaluated a function-tailored model of care (with a strong focus on activation of patients) combined with a state-of-the-art medical fast track pathway and a prehabilitation period if necessary.

Methods: By using an observational cohort study design we executed a monitoring led transition in 4 phases. Prospectively collected data from medical files were used to compare patients in the usual care period (Joint care, n= 171) and after introduction of the function tailored care pathway (n= 404), the fast track- (n= 721) and the prehabilitation period (N= 601). Evaluation targeted patients time to IROA, length of stay (LOS) and referrals of patients towards their home situation (in %). Multivariable regression was used to adjust the results for differences between patient groups.

Results: Between May 2009 and December 2020, 1853 people underwent primary TKR surgery. After each phase of implementations the % of patients with a referral towards their home increased when compared with usual care (69%), up to; 77% in the function tailored period, 91.6% in the fast track period and 92,6% in the prehabilitation period. Post hoc analysis revealed that the increase in % of patients with a referral towards their home was significant after the implementation of the fast track pathway (p<.001). LOS decreased significantly after each phase of implementation, respectfully; -1.1 days in the function tailored period (m= 4.1 days, p= .001), -0.6 days in the fast track period (m= 3.5 days, p= <.001), -0.6 days in the prehabilitation period (m= 2.9 days, p= <.001). IROA also decreased significantly after each phase of implementation, respectfully; -0,9 days in the function tailored period (m= 3.5 days, p=<.001), -0,6 days in the fast track period (m= 2.9 days, p=<.001) and -0.4 days in the prehabilitation period (m= 2.5 days, p=<.001).

Conclusions: When TKR care is optimized aiming at patients physical activity levels and functional independence during the entire patient trajectory it can result in; patients being functionally independent in a significantly shorter time period, more people being discharged towards their homes and significant shorter lengths of inhospital stay.

Implications: The results of this study give suggestions on how the care process of patients around TKR can be improved, by taking patients’ needs and preferences into account.

Funding acknowledgements: none

Keywords:
total knee replacement
inpatient recovery of activities
optimization of care

Topics:
Orthopaedics
Research methodology, knowledge translation & implementation science
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Nij Smellinghe Hospital

Committee: n/a

Ethics number: BK/AB/ID 17568