None listed
Conditions
Brief summary
Patients who undergo total hip replacement surgery traditionally have long surgical incisions, routine urinary catheters and wound drain tubes. Anesthesia involves 12 hours of oral restriction before and after surgery, a combination of local anesthetic blocks, spinal anaesthesia and sedation or general anesthesia. After surgery, patients have varying degrees of immobilization to avoid the risk of early hip dislocation and opioid pain relief which results in slow recovery and hospital discharge at day 4-6. Enhanced Recovery After Surgery (ERAS) principles for joint replacement surgery involve patient education, less invasive surgery, reduced fasting, regular oral analgesia and early ambulation. These principles are packaged together in a ‘bundle’ individualised for a particular hospital unit to account for local practices and preferences. Most ERAS programs have shown a remarkable improvement in patient recovery after joint replacement as measured by decreased hospital length of stay, improved mobilisation and patient satisfaction, with no increase in complications. This study aims to implement and evaluate a tailored ERAS program at Epworth HealthCare, a large private hospital with patients undergoing one-sided THR surgery by a single surgeon. Patients enrolled in the study will be evaluated from the time they are seen in the hospital preoperatively to discharge and followed up by a telephone call at 6 weeks. WHODAS 2.0 and QoR-15 questionnaires will assess patients’ return to health. The recovery of this group of patients will be compared to the recovery of a group of patients who underwent THR before the ERAS program was implemented.
Interventions
The exposed group is the group of patients undergoing THR with ERAS principles of care (October 2015 to April 2016).
The ERAS 'bundle' consists of several measures to be implemented
1. Preoperative patient information regarding the ERAS bundle. A leaflet will be given to patients by the surgeon at the time of booking for surgery.
2. Reduced fasting from clear fluids preoperatively (from midnight of the day of surgery, to 2 hours preoperative)
3. Reduced fasting from clear fluids postoperatively
The exposed group is the group of patients undergoing THR with ERAS principles of care (October 2015 to April 2016). The ERAS 'bundle' consists of several measures to be implemented 1. Preoperative patient information regarding the ERAS bundle. A leaflet will be given to patients by the surgeon at the time of booking for surgery. 2. Reduced fasting from clear fluids preoperatively (from midnight of the day of surgery, to 2 hours preoperative) 3. Reduced fasting from clear fluids postoperatively (from 4 hours after surgery, to 'as soon as awake and tolerating oral fluids'). 4. Anaesthetic technique to reduce postoperative drowsiness (spinal and propofol sedation or general anaesthesia) 5. Intraoperative antiemetics (dexamethasone 4mg intravenously and granisetron 1mg intravenously) 6. Use of forced air warmer ('Cocoon' forced air warming blanket over nonoperative part of patient) and fluid warmer ('Hotline' fluid warmer to warm intravenous fluids) intraoperatively. 7. Cefazolin 2g intravenously at least 15 minutes preincision 8. Regular postoperative multimodal oral analgesia (Panadol Osteo 2 tablets 8 hourly, meloxicam 15mg daily, Targin 10/5 or 20/10 twice daily) until no longer required for postoperative pain relief. Other oral analgesics as required. 9. Regular postoperative antiemetics for 24 hours (5HT-antagonist of choice - either granisetron 1mg intravenously twice daily or ondansetron 4mg intravenously twice daily). 10. Regular postoperative aperients (coloxyl with senna 2 tablets orally twice daily) until no longer required. 11. Clexane 40mg subcutaneously daily, for 21 days postoperatively. 12. Standardised mobilisation physiotherapy plan: Day 0 – mobilise on frame with physiotherapist Day 1 – mobilise on elbow crutches with physiotherapist, sit out of bed, shower with/without assistance Day 2 – independently mobilise with elbow crutches >50m, independent self-care activities Day 3 – independently transfer and mobilise with elbow crutches >100m, have a clear understanding of post-discharge progression of ambulation/exercise program and hip precautions. If applicable, independent with stairs and car transfers. * duration of each session is approximately 20 minutes, however will vary according to patient's ability to mobilise (varies with pain, nausea, dizziness). Data regarding factors that inhibit mobilisation will be collected. We will measure the implementation of the ERAS bundle (data collection as a process outcome on the Case Report Form) and whether implementation has improved patient recovery (Quality of Recovery-15 score).
Sponsors
Nicole Tan
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients over the age of 18 years at time of THR. 2. Patients undergoing unilateral THR. 3. Patients who can independently complete the study questionnaires. 4. Patients who have provided written informed consent.
Exclusion criteria
1. Patients who have previously been enrolled in the study at any time.
Outcome results
None listed