Plenge U, Nortje M B, Marais L C, Jordaan J D, Parker R, van der Westhuizen N, van der Merwe J F, Marais J, September W V, Davies G L, Pretorius T, Solomon C, Ryan P, Torborg A M, Farina Z, Smit R, Cairns C, Shanahan H, Sombili S, Mazibuko A, Hobbs H R, Porrill O S, Timothy N E, Siebritz R E, van der Westhuizen C, Troskie A J, Blake C A, Gray L A, Munting T W, Steinhaus H K S, Rowe P, van der Walt J G, Isaacs Noordien R, Theron A, Biccard B M
Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
BMC Musculoskelet Disord. 2018 May 9;19(1):140. doi: 10.1186/s12891-018-2062-2.
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.
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.
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.
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.
在高收入国家，基于强化康复路径方案的围手术期患者管理结构化方法有助于早期康复并降低发病率。然而，在低收入和中等收入国家（LMICs），实施强化康复路径的可行性及其对患者结局的影响鲜有研究。为了在LMICs为全髋关节和膝关节置换术提供类似实践指导，有必要确定适合LMICs的此类项目中可能包含的潜在因素。
采用德尔菲法，来自代表南非4个省份的10家国立医院的33名利益相关者（13名关节置换外科医生、12名麻醉师和8名物理治疗师）确定并对以下内容进行了优先级排序：i）与不良结局相关的危险因素；ii）改善结局的围手术期干预措施；iii）计划接受初次择期单侧全髋关节和膝关节置换术患者的实践基准所需的患者和临床结局。
33名利益相关者中有30名完成了为期3个月的德尔菲研究。第一轮产生了：i）36条术前危险因素建议；ii）14条（术前）、18条（术中）和23条（术后）改善结局的围手术期干预最佳实践建议；iii）25条术后重要结局建议。这些项目在后续轮次中由小组进行了优先级排序，并就每个类别中的前十大优先事项达成了共识。
通过共识得出的危险因素、围手术期干预措施和重要结局将为制定全髋关节和膝关节置换术的结构化围手术期多学科强化患者护理方案提供参考。预计本研究将为制定旨在改善LMICs关节置换术后患者结局的实用强化护理路径提供必要的架构。
