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Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: A quality improvement study

Tan, NLT, Hunt, JL and Gwini, SM 2018, Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: A quality improvement study, BMC Anesthesiology, vol. 18, no. 1, pp. 1-10, doi: 10.1186/s12871-018-0525-5.

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Title Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: A quality improvement study
Author(s) Tan, NLT
Hunt, JL
Gwini, SMORCID iD for Gwini, SM orcid.org/0000-0002-0295-4575
Journal name BMC Anesthesiology
Volume number 18
Issue number 1
Article ID 64
Start page 1
End page 10
Total pages 10
Publisher BMC
Place of publication London, Eng.
Publication date 2018-06-13
ISSN 1471-2253
Keyword(s) Enhanced recovery after surgery
Fast-track program
ERAS
Quality of recovery
Quality improvement
Observational study
Hip arthroplasty
Hip replacement
Summary Background: Enhanced recovery after surgery programs may improve recovery and reduce duration of hospital stay after joint replacement surgery. However, uptake is incomplete, and the relative importance of program components is unknown. This before-and-after quality improvement study was designed to determine whether adding ‘non-surgical’ components, to pre-existing ‘surgical’ components, in an Australian private healthcare setting, would improve patient recovery after total hip replacement. Methods: We prospectively collected data regarding care processes and health outcomes of 115 consecutive patients undergoing hip replacement with a single surgeon in a private hospital in Melbourne, Australia. Based on this data, a multidisciplinary team (surgeon, anesthetists, nurse unit managers, physiotherapists, perioperative physician) chose and implemented 12 ‘non-surgical’ program components. Identical data were collected from a further 115 consecutive patients. The primary outcome measure was Quality of Recovery-15 score at 6 weeks postoperatively; the linear regression model was adjusted for baseline group differences. Results: The majority of health outcomes, including the primary outcome measure, were similar in pre- and post-implementation groups (quality of recovery score, pain rating and disability score, at time-points up to six weeks postoperatively). The proportion of patients with zero oral morphine equivalent consumption at six weeks increased from 57 to 80% (RR 1.34, 95% CI 1.13, 1.58). Mean (SD) length of hospital stay decreased from 5.94 (5.21) to 5.02 (2.46) days but was not statistically significant once adjusted for baseline group differences. Four of ten measurable program components were successfully implemented. Antiemetic prophylaxis increased by 53% (risk ratio [RR] 95% confidence interval [CI] 1.16, 2.02). Tranexamic acid use increased by 41% (RR 95% CI 1.18, 1.68). Postoperative physiotherapy treatment on the day of surgery increased by 87% (RR 95% CI 1.36, 2.59). Postoperative patient mobilisation ≥ three metres on the day of surgery increased by 151% (RR 95% CI 1.27, 4.97). Conclusions: Implementation of a full enhanced recovery after surgery program, and optimal choice of program components, remains a challenge. Improved implementation of non-surgical components of a program may further reduce duration of acute hospital stay, while maintaining quality of recovery.
Language eng
DOI 10.1186/s12871-018-0525-5
Indigenous content off
Field of Research 1116 Medical Physiology
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30139520

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.