Abstract
Background
The Enhanced Recovery Programme (ERP) is an evidence based initiative aimed at speeding up patient recovery after major surgery and improving their outcomes. The Royal National Orthopaedic Hospital, Stanmore (RNOH) is a specialist orthopaedic and implemented an ERP for primary knee arthroplasties from October 2010.
Aims
To analyse the initial results of patients participating in our ERP for primary knee arthroplasty to identify what factors predict their Length of Stay (LoS) and establish where changes can be made to improve outcomes further.
Method
We interrogated our prospective ERP database and determined which patients achieved and which ones exceeded the 5-day LoS target. We then performed a further retrospective notes review to gather supplementary information including non-modifiable patient factors to identify factors which influenced their LoS.
Results
261 patients participated in the Knee ERP at the RNOH between October 2010 and December 2011 including patients undergoing complex procedures and bilateral procedures during the same in-patient episode.
Mean age was 64 years (32–85 years). Mean LoS was 6.1 days (2–29 days).
ASA grade and attendance at the multidisciplinary Joint School all had a positive influence on the LoS, particularly when combined.
The day of mobilisation had the greatest correlation with those mobilising early. Mean LoS was 2.8 (Day 0), 4.41 (Day 1), 6.38 (Day 2), 9.23 (Day 3) and 12.95 (Day 4 or later).
Conclusion
Identifying and targeting modifiable variables can further improve the outcomes for this particular group of patients.
ASA grade and attendance at the multidisciplinary Joint School are among the positive influences on patient LoS. Adjusting analgesia to reduce unwanted effects may facilitate earlier engagement with the physiotherapy service and thus earlier mobilisation. Early results suggest encouraging patients to attend Joint School with subsequently early postoperative mobilisation can positively influence safe return to the home environment.
