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Plenge U, Nortje MB, Marais LC, Jordaan JD, Parker R, van der Westhuizen N, van der Merwe JF, Marais J, September WV, Davies GL, Pretorius T, Solomon C, Ryan P, Torborg AM, Farina Z, Smit R, Cairns C, Shanahan H, Sombili S, Mazibuko A, Hobbs HR, Porrill OS, Timothy NE, Siebritz RE, van der Westhuizen C, Troskie AJ, Blake CA, Gray LA, Munting TW, Steinhaus HKS, Rowe P, van der Walt JG, Isaacs Noordien R, Theron A, Biccard BM. Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study. BMC Musculoskelet Disord 2018; 19:140. [PMID: 29743063 PMCID: PMC5944094 DOI: 10.1186/s12891-018-2062-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/26/2018] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- U Plenge
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - M B Nortje
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - L C Marais
- Department of Orthopaedic surgery, School of Clinical Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - J D Jordaan
- Department of Orthopaedic Surgery, Tygerberg Medical School, University of Stellenbosch, Cape Town, South Africa
| | - R Parker
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N van der Westhuizen
- Department Anaesthesia, University of the Free State, Bloemfontein, South Africa
| | - J F van der Merwe
- Department of Orthopaedic surgery, University of the Free State, Bloemfontein, South Africa
| | - J Marais
- Department of Physiotherapy, Paarl Provincial Hospital, Paarl, South Africa
| | - W V September
- Department of Physiotherapy, Paarl Provincial Hospital, Paarl, South Africa
| | - G L Davies
- Department of Anaesthesia, Paarl Provincial Hospital, Paarl, South Africa
| | - T Pretorius
- Department of Anaesthesia, Paarl Provincial Hospital, Paarl, South Africa
| | - C Solomon
- Department of Orthopaedics, Paarl Provincial Hospital, Paarl, South Africa
| | - P Ryan
- Arthroplasty and Sports Medicine unit, Department of Orthopaedics, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - A M Torborg
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Z Farina
- Department of Anaesthesia, Critical Care and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
| | - R Smit
- Department of Orthopaedic surgery, Grey's Hospital, Pietermaritzburg, South Africa
| | - C Cairns
- Greys Pain clinic, Department of Anaesthesia, Grey's Hospital, Pietermaritzburg, South Africa
| | - H Shanahan
- Department of Physiotherapy, Grey's Hospital, Pietermaritzburg, South Africa
| | - S Sombili
- Department of Orthopaedic surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - A Mazibuko
- Department of Anaesthesia, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - H R Hobbs
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - O S Porrill
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N E Timothy
- Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R E Siebritz
- Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - A J Troskie
- Department of Orthopaedic Surgery, Worcester Hospital, Worcester, South Africa
| | - C A Blake
- Department of Orthopaedic Surgery, Worcester Hospital, Worcester, South Africa
| | - L A Gray
- Department of Physiotherapy, New Somerset Hospital, Cape Town, South Africa
| | - T W Munting
- Department of Orthopaedics, New Somerset Hospital and Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - H K S Steinhaus
- Department of Anaesthesia, New Somerset Hospital, Cape Town, South Africa
| | - P Rowe
- Department of Orthopaedic surgery, Victoria Hospital, Cape Town, South Africa
| | - J G van der Walt
- Department of Anaesthesia, Victoria Hospital, Cape Town, South Africa
| | - R Isaacs Noordien
- Department of Physiotherapy, Victoria Hospital, Cape Town, South Africa
| | - A Theron
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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