Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study

被引：11

作者：

Plenge, U. ^{[1
,2
]}

Nortje, M. B. ^{[2
,3
]}

Marais, L. C. ^{[4
]}

Jordaan, J. D. ^{[5
]}

Parker, R. ^{[1
,2
]}

van der Westhuizen, N. ^{[6
]}

van der Merwe, J. F. ^{[7
]}

Marais, J. ^{[8
]}

September, W., V ^{[8
]}

Davies, G. L. ^{[9
]}

Pretorius, T. ^{[9
]}

Solomon, C. ^{[10
]}

Ryan, P. ^{[11
]}

Torborg, A. M. ^{[12
]}

Farina, Z. ^{[13
]}

Smit, R. ^{[14
]}

Cairns, C. ^{[15
]}

Shanahan, H. ^{[16
]}

Sombili, S. ^{[17
]}

Mazibuko, A. ^{[18
]}

Hobbs, H. R. ^{[2
,3
]}

Porrill, O. S. ^{[1
,2
]}

Timothy, N. E. ^{[2
,19
]}

Siebritz, R. E. ^{[2
,19
]}

van der Westhuizen, C. ^{[20
]}

Troskie, A. J. ^{[21
]}

Blake, C. A. ^{[21
]}

Gray, L. A. ^{[22
]}

Munting, T. W. ^{[23
,24
]}

Steinhaus, H. K. S. ^{[25
]}

Rowe, P. ^{[26
]}

van der Walt, J. G. ^{[27
]}

Noordien, R. Isaacs ^{[28
]}

Theron, A. ^{[29
]}

Biccard, B. M. ^{[1
,2
]}

机构：

[1] Univ Cape Town, Groote Schuur Hosp, Dept Anaesthesia & Perioperat Med, Cape Town, South Africa

[2] Univ Cape Town, Fac Hlth Sci, Cape Town, South Africa

[3] Univ Cape Town, Groote Schuur Hosp, Dept Orthopaed Surg, Cape Town, South Africa

[4] Univ KwaZulu Natal, Sch Clin Med, Dept Orthopaed Surg, Pietermaritzburg, South Africa

[5] Univ Stellenbosch, Tygerberg Med Sch, Dept Orthopaed Surg, Cape Town, South Africa

[6] Univ Free State, Dept Anaesthesia, Bloemfontein, South Africa

[7] Univ Free State, Dept Orthopaed Surg, Bloemfontein, South Africa

[8] Paarl Prov Hosp, Dept Physiotherapy, Paarl, South Africa

[9] Paarl Prov Hosp, Dept Anaesthesia, Paarl, South Africa

[10] Paarl Prov Hosp, Dept Orthopaed, Paarl, South Africa

[11] Univ KwaZulu Natal, Inkosi Albert Luthuli Cent Hosp, Dept Orthopaed, Arthroplasty & Sports Med unit, Durban, South Africa

[12] Univ KwaZulu Natal, Inkosi Albert Luthuli Cent Hosp, Dept Anaesthesia, Durban, South Africa

[13] Greys Hosp, Dept Anaesthesia Crit Care & Pain Management, Pietermaritzburg, South Africa

[14] Greys Hosp, Dept Orthopaed Surg, Pietermaritzburg, South Africa

[15] Greys Hosp, Dept Anaesthesia, Greys Pain Clin, Pietermaritzburg, South Africa

[16] Greys Hosp, Dept Physiotherapy, Pietermaritzburg, South Africa

[17] Univ Pretoria, Steve Biko Acad Hosp, Dept Orthopaed Surg, Pretoria, South Africa

[18] Univ Pretoria, Steve Biko Acad Hosp, Dept Anaesthesia, Pretoria, South Africa

[19] Univ Cape Town, Groote Schuur Hosp, Dept Physiotherapy, Cape Town, South Africa

[20] Worcester Hosp, Dept Anaesthesia, Worcester, South Africa

[21] Worcester Hosp, Dept Orthopaed Surg, Worcester, South Africa

[22] New Somerset Hosp, Dept Physiotherapy, Cape Town, South Africa

[23] New Somerset Hosp, Dept Orthopaed, Cape Town, South Africa

[24] Christiaan Barnard Mem Hosp, Cape Town, South Africa

[25] New Somerset Hosp, Dept Anaesthesia, Cape Town, South Africa

[26] Victoria Hosp, Dept Orthopaed Surg, Cape Town, South Africa

[27] Victoria Hosp, Dept Anaesthesia, Cape Town, South Africa

[28] Victoria Hosp, Dept Physiotherapy, Cape Town, South Africa

[29] Univ Stellenbosch, Tygerberg Acad Hosp, Dept Anaesthesiol & Crit Care, Cape Town, South Africa

来源：

BMC MUSCULOSKELETAL DISORDERS | 2018年 / 19卷

关键词：

Delphi study; Enhanced recovery pathways; Low middle income countries; Total hip and knee arthroplasty; Total hip and knee replacement; Patient outcomes; ENHANCED RECOVERY; SURGICAL HOME; SURGERY; IMPLEMENTATION; MANAGEMENT; PATIENT; TRIALS; HEALTH; AUDIT; CORE;

D O I：

10.1186/s12891-018-2062-2

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background: A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low-and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods: Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results: Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion: The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.

引用

页数：6

共 21 条

[1] French guidelines for enhanced recovery after elective colorectal surgery [J].