Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study
| Autor: | JF van der Merwe, Simon Sombili, M Nortje, Renee Smit, N.E. Timothy, P Ryan, CA Blake, H. Shanahan, Owen S Porrill, A.N. Mazibuko, J. Marais, Z. Farina, A.K. Theron, Bruce M Biccard, J.D. Jordaan, N. Van der Westhuizen, L.A. Gray, T Pretorius, P. Rowe, T.W. Munting, G Davies, W.V. September, R.E. Siebritz, R. Isaacs Noordien, A.J. Troskie, U. Plenge, J. G. van der Walt, Alexandra Torborg, Leonard C Marais, H Steinhaus, C. van der Westhuizen, Romy Parker, C. Solomon, H.R. Hobbs, C. Cairns |
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| Přispěvatelé: | Department of Anaesthesia, Faculty of Health Sciences |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system Consensus Sports medicine Delphi Technique medicine.medical_treatment Best practice Arthroplasty Replacement Hip Health Personnel Enhanced recovery pathways Psychological intervention Delphi method Perioperative Care 03 medical and health sciences South Africa 0302 clinical medicine Total hip and knee replacement Rheumatology 030202 anesthesiology Epidemiology Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Low middle income countries Arthroplasty Replacement Knee Rehabilitation business.industry Perioperative Arthroplasty Delphi study Total hip and knee arthroplasty Patient outcomes Physical therapy lcsh:RC925-935 business Research Article |
| Zdroj: | BMC Musculoskeletal Disorders BMC Musculoskeletal Disorders, Vol 19, Iss 1, Pp 1-6 (2018) |
| ISSN: | 1471-2474 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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