Chua Matthew J, Hart Andrew J, Mittal Rajat, Harris Ian A, Xuan Wei, Naylor Justine M
University of New South Wales, Sydney, New South Wales, Australia.
Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia.
PLoS One. 2017 Jun 27;12(6):e0179820. doi: 10.1371/journal.pone.0179820. eCollection 2017.
Early mobilisation is recommended following total hip arthroplasty (THA) or total knee arthroplasty (TKA) to prevent venous thromboembolism (VTE). We sought to determine the proportions of patients that first mobilised on post-operative day 0 (POD 0) and factors associated with earlier time to mobilisation.
A prospective cohort study was conducted involving patients with hip or knee osteoarthritis who had undergone primary unilateral THA (n = 818) and TKA (n = 989) at 19 Australian hospitals. Patient-related (e.g. age, gender, body mass index), treatment-related (e.g. hospital site, presence of indwelling catheter) and mobilisation-related variables were collected on standardised forms. Time was measured by post-operative days, where POD 0 was defined as the day of surgery ending at midnight. Multivariate Poisson regression analysis identified associations between patient- and treatment-related covariates and time to mobilisation.
Inter-hospital variation was evident, but overall, only 9.4% of THA and 5.6% of TKA patients mobilised on POD 0. For THA patients, earlier time to mobilisation was associated with hospital site and absences of an indwelling catheter and acute complications. For TKA patients, earlier time to mobilisation was associated with hospital site and absence of donor blood transfusion.
Few THA and TKA patients mobilise POD 0, although some hospitals appear more aggressive with their mobilisation attempts than others. Treatment-related factors, not patient-related, are associated with post-operative day of mobilisation, indicating the potentially pivotal role of service providers in promoting early mobilisation to improve health outcomes and reduce rates of VTE.
全髋关节置换术（THA）或全膝关节置换术（TKA）后建议早期活动以预防静脉血栓栓塞症（VTE）。我们试图确定术后第0天（POD 0）首次活动的患者比例以及与更早开始活动时间相关的因素。
对澳大利亚19家医院中接受初次单侧THA（n = 818）和TKA（n = 989）的髋或膝骨关节炎患者进行了一项前瞻性队列研究。通过标准化表格收集患者相关（如年龄、性别、体重指数）、治疗相关（如医院地点、留置导管情况）和活动相关变量。时间以术后天数衡量，其中POD 0定义为手术日结束于午夜的那一天。多变量泊松回归分析确定了患者和治疗相关协变量与活动时间之间的关联。
医院间差异明显，但总体而言，只有9.4%的THA患者和5.6%的TKA患者在POD 0活动。对于THA患者，更早开始活动与医院地点、无留置导管和无急性并发症有关。对于TKA患者，更早开始活动与医院地点和无异体输血有关。
很少有THA和TKA患者在POD 0活动，尽管一些医院在活动尝试上比其他医院更积极。与活动时间相关的是治疗相关因素而非患者相关因素，这表明服务提供者在促进早期活动以改善健康结局和降低VTE发生率方面可能发挥关键作用。
