Influence of outpatient total knee arthroplasty compared to inpatient surgery on medical and economic outcomes / Vincent Tomasi in Acta Orthopaedica Belgica, Vol.87/1 (Mars 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/1 (Mars 2021) . - p. 103-109 Titre : Influence of outpatient total knee arthroplasty compared to inpatient surgery on medical and economic outcomes Type de document : texte imprimé Auteurs : Vincent Tomasi ; Alex Demurie ; Ignace Ghijselings ; Olivier Cornu ; Hans Van Den Wyngaert Année de publication : 2021 Article en page(s) : p. 103-109 Note générale : https://doi.org/10.52628/87.1.13 Langues : Anglais (eng) Mots-clés : Total knee arthroplasty  outpatient  fast-track program  complications  discharge criteria Résumé : Firstly, this study compared the rate of readmission after a total knee arthroplasty between selected out- patients (no hospitalization, directly sent home after surgery) and inpatients (3 days hospitalization) at 6 weeks. Secondly, it examined the mobility and the complications in the two groups after the same period of time. The rate of readmission, complications and knee mobility of 32 outpatients (M-age : 61 years ± 10 ; 10 females), were compared against those of 32 birth- matched inpatients (M-age : 64 years ± 8.6 ; 10 females). No patient was re-admitted in either group. Post- surgical complications included one hematoma resorbed at 6 weeks in the outpatient group and three joint effusions in the inpatient group. There were no instances of deep venous thrombosis, failure of primary fixation, infection, or wound dehiscence. Knee mobility was identical between the two groups. This is the first study to compare inpatient and outpatient total knee arthroplasty in a Belgian setting. Our study suggests that day-care total knee arthroplasty in selected patients is possible without increasing the rate of re-admission and complications, and without affecting the mobility at 6 weeks. However, the Belgian financial incentives do not seem to currently promote this surgical approach. These results should be confirmed with a larger sample to define the adequate length of stay after a total knee arthroplasty. Permalink : ./index.php?lvl=notice_display&id=96592 [article] Influence of outpatient total knee arthroplasty compared to inpatient surgery on medical and economic outcomes [texte imprimé] / Vincent Tomasi ; Alex Demurie ; Ignace Ghijselings ; Olivier Cornu ; Hans Van Den Wyngaert . - 2021 . - p. 103-109. https://doi.org/10.52628/87.1.13 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/1 (Mars 2021) . - p. 103-109 Mots-clés : Total knee arthroplasty  outpatient  fast-track program  complications  discharge criteria Résumé : Firstly, this study compared the rate of readmission after a total knee arthroplasty between selected out- patients (no hospitalization, directly sent home after surgery) and inpatients (3 days hospitalization) at 6 weeks. Secondly, it examined the mobility and the complications in the two groups after the same period of time. The rate of readmission, complications and knee mobility of 32 outpatients (M-age : 61 years ± 10 ; 10 females), were compared against those of 32 birth- matched inpatients (M-age : 64 years ± 8.6 ; 10 females). No patient was re-admitted in either group. Post- surgical complications included one hematoma resorbed at 6 weeks in the outpatient group and three joint effusions in the inpatient group. There were no instances of deep venous thrombosis, failure of primary fixation, infection, or wound dehiscence. Knee mobility was identical between the two groups. This is the first study to compare inpatient and outpatient total knee arthroplasty in a Belgian setting. Our study suggests that day-care total knee arthroplasty in selected patients is possible without increasing the rate of re-admission and complications, and without affecting the mobility at 6 weeks. However, the Belgian financial incentives do not seem to currently promote this surgical approach. These results should be confirmed with a larger sample to define the adequate length of stay after a total knee arthroplasty. Permalink : ./index.php?lvl=notice_display&id=96592

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Outpatient total hip arthroplasty : the future? / Solange de Wouters in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 313-319 Titre : Outpatient total hip arthroplasty : the future? Type de document : texte imprimé Auteurs : Solange de Wouters ; Steven Petronilia ; Daniel Paulet ; Tom De Baere ; Etienne Willemart ; Olivier Cornu Année de publication : 2021 Article en page(s) : p. 313-319 Note générale : https://doi.org/10.52628/87.2.16 Langues : Anglais (eng) Mots-clés : total hip arthroplasty  outpatient  ambulatory  safety Résumé : With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety. Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered. Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience. With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied. Permalink : ./index.php?lvl=notice_display&id=96666 [article] Outpatient total hip arthroplasty : the future? [texte imprimé] / Solange de Wouters ; Steven Petronilia ; Daniel Paulet ; Tom De Baere ; Etienne Willemart ; Olivier Cornu . - 2021 . - p. 313-319. https://doi.org/10.52628/87.2.16 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 313-319 Mots-clés : total hip arthroplasty  outpatient  ambulatory  safety Résumé : With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety. Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered. Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience. With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied. Permalink : ./index.php?lvl=notice_display&id=96666

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Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review / Kouamé Jean-Eric Kouassi in Acta Orthopaedica Belgica, Vol.87/1 (Mars 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/1 (Mars 2021) . - p. 85-92 Titre : Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review Type de document : texte imprimé Auteurs : Kouamé Jean-Eric Kouassi ; Julie Manon ; Loïc Fonkoue ; Christine Detrembler ; Olivier Cornu Année de publication : 2021 Article en page(s) : p. 85-92 Note générale : https://doi.org/10.52628/87.1.11 Langues : Anglais (eng) Mots-clés : Africa  cast immobilization  developing countries  open fracture  tibia Résumé : Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost. Permalink : ./index.php?lvl=notice_display&id=96590 [article] Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review [texte imprimé] / Kouamé Jean-Eric Kouassi ; Julie Manon ; Loïc Fonkoue ; Christine Detrembler ; Olivier Cornu . - 2021 . - p. 85-92. https://doi.org/10.52628/87.1.11 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/1 (Mars 2021) . - p. 85-92 Mots-clés : Africa  cast immobilization  developing countries  open fracture  tibia Résumé : Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost. Permalink : ./index.php?lvl=notice_display&id=96590

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