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Implementation of an enhanced recovery after surgery program including a patient school: Impact on quality of life results

  • B Somoza-Fernández
    Correspondence
    Corresponding author.
    Affiliations
    Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • A Ribed-Sánchez
    Affiliations
    Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • S Martín-Lozano
    Affiliations
    Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • FM de Vega-San Vicente
    Affiliations
    Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • R Menéndez-Tarín
    Affiliations
    Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • Á Giménez-Manzorro
    Affiliations
    Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • P Sanz-Ruiz
    Affiliations
    Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • I Garutti-Martínez
    Affiliations
    Anesthesiology and Resuscitation Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • A Herranz-Alonso
    Affiliations
    Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • J Vaquero-Martín
    Affiliations
    Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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  • M Sanjurjo-Sáez
    Affiliations
    Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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Published:October 02, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.063

      Highlights

      • Patients’ involvement in their own surgical process in the context of the implementation of a patient school, showed optimal patient satisfaction rates and patient reported outcomes (PROS).
      • The implementation of an ERAS programme showed optimal health outcomes comparing with historical data, with a short hospital stay length, and no surgery cancellations.
      • New multimodal analgesic regimens were associated to a fast recovery and high satisfaction rates with pain management during hospitalisation.

      Abstract

      Introduction

      Enhanced Recovery After Surgery (ERAS) protocols and educational programmes have been shown to accelerate orthopaedic surgery recovery with fewer complications, and improve patient-reported outcomes (PROs) for different types of surgery. The objective was to evaluate the impact of an ERAS programme including a patient school on health outcomes and PROs for Total Knee Replacement (TKR) surgery.

      Material and methods

      A multidisciplinary group created the programme and the patient school (preoperative consultations where the patients’ surgical processes are explained and are also given instructions for an appropriate perioperative care management). An observational, prospective study was conducted on all patients operated for TKR from March 2021 to March 2022. Main health outcomes were: hospital stay length, surgical complications and surgery cancellations due to a wrong preoperative medication management. PROs evaluated were: patient satisfaction with pain management, the school, and quality of life before and after surgery (EQ-5D).

      Results

      One hundred thirty-three patients were included. Median hospital stay length was 3 days (IQR 3-5). Rate of surgical complications was 25.6%. No surgery was cancelled. Patient satisfaction rates with pain management and with the school were 8.10/10 and 9.89/10, respectively. Concerning quality of life, mean improvement in mobility and knee pain after the surgery was 0.66 (p < 0.05) and 0.84 (p < 0.05), respectively.

      Conclusions

      The ERAS programme including a patient school was highly successful with a fast recovery, a short hospital stay length, no surgery cancellations, and improved PROs.

      Keywords

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      References

        • Losina E.
        • Thornhill T.S.
        • Rome B.N.
        • Wright J.
        • Katz J.N.
        The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic.
        J Bone Joint Surg Am. 2012; 94: 201
        • Fernández M.E.
        Análisis de la calidad de vida en pacientes con prótesis total de rodilla.
        Salamanca University, Spain2013
        • García E.
        Evaluación de la estancia hospitalaria en la prótesis de cadera.
        Alcalá University, Madrid, Spain2011
        • Rodríguez E.C.
        Cirugía ortopédica y traumatología de la rodilla. Estado actual.
        1st ed. Editorial Médica Panamericana, Madrid2011
        • Bourne R.B.
        • Chesworth B.M.
        • Davis A.M.
        • Mahomed N.N.
        • Charron K.D.J.
        Patient satisfaction after total knee arthroplasty.
        Clin Orthop Relat Res. 2010; 468: 57-63
        • Gungor S.
        • Fields K.
        • Aiyer R.
        • González A.
        • Su E.P.
        Incidence and risk factors for development of persistent postsurgical pain following total knee arthroplasty.
        Medicine. 2019; 98: 28
        • Charipova K.
        • Gress K.L.
        • Urits I.
        • Viswanath O.
        • Kaye A.D.
        Management of patients with chronic pain in ambulatory surgery centers.
        Cureus. 2020; 12: e10408
        • Soffin E.M.
        • Gibbons M.M.
        • Ko C.Y.
        • Kates S.L.
        • Wick E.C.
        • Cannesson M.
        • et al.
        Evidence review conducted for the agency for healthcare research and quality safety program for improving surgical care and recovery: focus on anesthesiology for total knee arthroplasty.
        Anesth Analg. 2019; 128: 454-465
        • Graffigna G.
        • Baerllo S.
        Patient health engagement (PHE) model in enhanced recovery after surgery (ERAS): monitoring patients’ engagement and psychological resilience in minimally invasive thoracic surgery.
        J Thorac Dis. 2018; 10: 517-528
        • Coulter A.
        • Ellins J.
        Effectiveness of strategies for informing, educating and involving patients.
        BMJ. 2007; 335: 24-27
        • Whinney C.
        Perioperative medication management: general principles and practical applications.
        Cleve Clin J Med. 2009; 76: 126-132
        • Hartwig S.C.
        • Denger S.D.
        • Schneider P.J.
        Severity-indexed, incident report-based medication error-reporting program.
        Am J Hosp Pharm. 1991; 48: 2611-2616
        • Wainwright T.W.
        • Gill M.
        • McDonald D.A.
        • Middleton R.G.
        • Reed M.
        • Sahota O.
        • et al.
        Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS®) society recommendations.
        Acta Orthop. 2020; 91: 3-19
        • Pamilo K.J.
        • Torkki P.
        • Peltola M.
        • Pesola M.
        • Remes V.
        • Paloneva J.
        Fast-tracking for total knee replacement reduces use of institutional care without compromising quality.
        Acta Orthop. 2017; 88: 184-189
        • Pitter F.T.
        • Jørgensen C.C.
        • Lindberg-Larsen M.
        • Kehlet H.
        Postoperative morbidity and discharge destinations after fast-track hip and knee arthroplasty in patients older than 85 years.
        Anesth Analg. 2016; 122: 1807-1815
        • Dean H.F.
        • Carter F.
        • Francis N.K.
        Modern perioperative medicine – past, present, and future.
        Innov Surg Sci. 2019; 4: 123-131
        • Frassanito L.
        • Vergari A.
        • Nestorini R.
        • Cerulli G.
        • Placella G.
        • Pace V.
        • et al.
        Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery.
        Musculoskelet Surg. 2020; 104: 87-92
        • Vendittoli P.A.
        • Pellei K.
        • Desmeules F.
        • Massé V.
        • Loubert C.
        • Lavigne M.
        • et al.
        Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs.
        Orthop Traumatol Surg Res. 2019; 105: 1237-1243
        • Ripollés J.
        • Fuenmayor M.L.
        • Camargo S.
        • Fernández P.J.
        • Barrio A.
        • Martínez-Hurtado E.
        • et al.
        Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study.
        Braz J Anesthesiol. 2018; 68: 358-368
        • Wei B.
        • Tang C.
        • Li X.
        • Lin R.
        • Han L.
        • Zheng S.
        • et al.
        Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial. l.
        BMC Musculoskelet Disord. 2021; 22: 856
        • Gan T.J.
        Poorly controlled postoperative pain: prevalence, consequences, and prevention.
        J Pain Res. 2017; 10: 2287-2298
        • Kahokkehr A.
        • Sammour T.
        • Zargar-Shoshtari K.Z.
        • Thompson L.
        • Hill A.G.
        Implementation of ERAS and how to overcome the barriers.
        Int J Surg. 2009; 7: 16-19
        • De Lorenzo A.
        • Ortega C.
        • Ribed A.
        • Giménez Á.
        • Ibáñez S.
        • de Miguel Á.
        • et al.
        Cancellations of elective surgical procedures due to inadequate management of chronic medications.
        J Clin Pharm Ther. 2019; 00: 1-4