Department of Biomedical Sciences, Faculty of Graduate and Postdoctoral Studies, Université de Montréal, Montreal, Quebec, Canada.
Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada.
BMC Musculoskelet Disord. 2021 Nov 23;22(1):978. doi: 10.1186/s12891-021-04847-9.
Optimizing patients' total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs.
We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients' characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together.
The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients' THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (r = + [0.36-0.66], p-value < 0.01).
Whatever the perioperative program, the key to improving patients' THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients' experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients' THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.
优化患者全髋关节和膝关节置换术（THA/TKA）体验对于提供高质量的护理至关重要，就像提高安全性和临床效果一样重要。然而，关于标准住院和手术后强化康复（ERAS）门诊计划中患者体验的证据很少。因此，本研究旨在更深入地了解 ERAS 门诊计划与标准住院计划相比患者的体验。
我们对 48 名连续接受标准住院和 ERAS 门诊双侧 THA/TKA 的患者进行了一项收敛性混合方法研究。基于通过问卷收集的数据进行了反思性主题分析。对患者体验与患者特征、临床结果和护理组件满意度之间的相关性进行了双变量相关性分析。然后，将定量和定性数据整合在一起。
患者认为“支持带来更好和更差的差异”这一主题对于他们在两个关节置换计划中的体验至关重要。另一方面，患者确定了 3 个主题，可以区分他们的 ERAS 门诊和标准住院体验：1）尽量减少不便，2）家的感觉真好，3）恢复正常功能和活动。患者提出的潜在优化方案是获得更多术前信息、额外的术后康复课程，并确保医院和家庭护理团队之间的护理更连贯。患者的 THA/TKA 体验与对疼痛管理、住院时间、术后恢复、家庭护理和整体结果的满意度之间存在弱到中度的正相关，相关性为+[0.36-0.66]，p 值<0.01。
无论围手术期计划如何，改善患者 THA/TKA 体验的关键在于改善整个护理过程中的支持。然而，与标准住院护理相比，ERAS 门诊计划通过提供术后护理方面的专门支持、减少术后不便、优化疼痛管理、更早回家、更早恢复和恢复功能来改善患者的体验。通过优化向患者提供的信息、康复计划和护理团队之间的连贯性，可以进一步提高患者的 THA/TKA 体验。
