Ismet Koksal, Mesut Tahta, Mehmet Simsek, Metin Dogan, Murat Bozkurt

Total diz artroplastisi uygulanan hastalarda rapıd recovery protokolünün etkinliği

Amaç: Total diz artroplastisi uygulanan hastalarda mevcut standart protokol ile rapid recovery protokolünü maliyet - etkinlik ve klinik sonuçlar açısından karşılaştırmaktır.Hastalar ve Yöntem: Çalışmaya, primer elektif total diz artroplastisi uygulanan ve en az 6 aylık süre boyunca takip edilmiş olan hastalar dahil edildi. . Rapid recovery protokolü uygulanan 96 hasta (Grup 1) ile standart protokol uygulanmış olan 108 hasta (Grup 2) değerlendirmeye alındı. Tüm hastalara standart total diz artroplastisi uygulandı. Her iki prosedür de farklı tedavi planlarının felsefesine uygun olarak standardize edildi. Ameliyat sonrası hastanede yatış süresine, toplam finansal giderlere, ameliyat sonrası cerrahi enfeksiyon oranlarına, 6.ay AKSS fonksiyon skorlarına ve 6.ay diz fleksiyon – ekstansiyon derecelerine ait veriler hastaların kayıt dosyalarından toplanarak her iki grubun karşılaştırması yapıldıBulgular: Toplam 169 hasta değerlendirmeye alındı. Grup 1’deki hastaların postoperatif hastanede kalış süresi daha kısaydı ve istatistiksel olarak anlamlıydı (p=0.021). Grup 1’deki toplam maliyet daha düşüktü ve anlamlydı (p=0.041). Grup 1’deki enfeksiyon oranları daha düşüktü ve anlamlıydı (p=0.034). 6. aydaki AKSS fonksiyon skorları Grup 1’deki hastalarda daha yüksek ve anlamlıydı (p=0.032). 6. aydaki fleksiyon ve ekstansiyon dereceleri Grup 1’deki hastalarda daha fazlaydı ve anlamlıydı (Sırasyıla p=0.04, p=0.48)Sonuç: Total diz artroplastisi yapılan hastalara rapid recovery protokolünün uygulanması ile toplam maliyetin azaldığı, enfeksiyon oranlarının azaldığı, hasta memnuniyetinin arttığı ve mükemmel fonksiyonel sonuçların alındığı görülmektedir. Rapid recovery protokolü hem total diz artroplastisi uygulanan hastalar için hem de sağlık hizmetini finanse eden kurumlar için oldukça faydalı olabilir.Anahtar Kelimeler: Total diz artroplastisi, rapid recovery. DOI: 10.3944/AOTT.2015.14.0353

Anahtar Kelimeler:

Maliyet etkinliği; rapid recovery; rehabilitasyon; total diz artroplastisi

Efficacy of rapid recovery protocol for total knee arthroplasty: a retrospective study

Objective: Our aim was to compare the clinical results and cost-effectiveness of a rapid recovery protocol for total knee arthroplasty (TKA) with a current standard protocol.Methods: The study included patients undergoing primary elective TKA with at least 6 months of follow-up. The rapid recovery protocol was applied to 96 patients (Group 1) and the standard protocol to 108 (Group 2). All patients underwent standard TKA. All pre-, peri-, and postoperative procedures in the treatment and follow-up of patients were appropriately standardized to the philosophies of the different treatment plans. The postoperative length of hospital stay, total financial cost, postoperative surgical infection, 6-month American Knee Society scores, and knee range of motion (ROM) were compared between the groups.Results: A total of 169 patients were included. Group 1 patients had significantly shorter postoperative length of hospital stay (p=0.021), significantly lower mean total financial cost (p=0.041), significantly lower infection rates (p=0.034), and significantly higher 6-month knee function scores (p=0.032). In comparison with Group 2, Group 1 knee flexion (p=0.04) and extension (p=0.48) ROM at 6 months postoperatively were both significantly improved.Conclusion: Application of the rapid recovery protocol to patients who underwent TKA reduced costs and infection rates and improved functional results.

Keywords:

Accelerated discharge, cost-effectiveness, rehabilitation total knee arthroplasty,

PDF

___

Kim YH, Kim JS, Choe JW, Kim HJ. Long-term compari- son of fixed-bearing and mobile-bearing total knee replace- ments in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am 2012;94:866–73.
Bae DK, Song SJ, Park MJ, Eoh JH, Song JH, Park CH. Twenty-year survival analysis in total knee arthroplasty by a single surgeon. J Arthroplasty 2012;27:1297–304.e1.
Lovald ST, Ong KL, Lau EC, Schmier JK, Bozic KJ, Kurtz SM. Mortality, cost, and health outcomes of total knee arthroplasty in Medicare patients. J Arthroplasty 2013;28:449–54.
Larsen K, Hansen TB, Thomsen PB, Christiansen T, Sİballe K. Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplas- ty. J Bone Joint Surg Am 2009;91:761–72.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–4.
Irisson E, Hémon Y, Pauly V, Parratte S, Argenson JN, Kerbaul F. Tranexamic acid reduces blood loss and finan- cial cost in primary total hip and knee replacement surgery. Orthop Traumatol Surg Res 2012;98:477–83.
den Hartog YM, Mathijssen NM, Vehmeijer SB. Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures. Acta Or- thop 2013;84:444–7.
Larsen K, Sİrensen OG, Hansen TB, Thomsen PB, Sİballe K. Accelerated perioperative care and rehabilita- tion intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 2008;79:149–59.
Healy WL, Iorio R, Ko J, Appleby D, Lemos DW. Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am 2002;84-A:348–53.
Larsen K, Hansen TB, Sİballe K. Hip arthroplasty pa- tients benefit from accelerated perioperative care and reha- bilitation: a quasi-experimental study of 98 patients. Acta Orthop 2008;79:624–30.
Berend KR, Lombardi AV Jr, Mallory TH. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int 2004;13:239–47.
Larsen K, Hvass KE, Hansen TB, Thomsen PB, Sİballe K. Effectiveness of accelerated perioperative care and re- habilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up. BMC Musculoskelet Disord 2008;9:59.
Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H. Fast-track surgery for bilateral total knee re- placement. J Bone Joint Surg Br 2011;93:351–6.
Reilly KA, Beard DJ, Barker KL, Dodd CA, Price AJ, Murray DW. Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty-a ran- domised controlled trial. Knee 2005;12:351–7.
McDonald S, Hetrick S, Green S. Pre-operative education for hip or knee replacement. Cochrane Database Syst Rev 2004;1:CD003526.