Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study

U. Plenge; M. B. Nortje; L. C. Marais; J. D. Jordaan; R. Parker; N. van der Westhuizen; J. F. van der Merwe; J. Marais; W. V. September; G. L. Davies; T. Pretorius; C. Solomon; P. Ryan; A. M. Torborg; Z. Farina; R. Smit; C. Cairns; H. Shanahan; S. Sombili; A. Mazibuko; H. R. Hobbs; O. S. Porrill; N. E. Timothy; R. E. Siebritz; C. van der Westhuizen; A. J. Troskie; C. A. Blake; L. A. Gray; T. W. Munting; H. K. S. Steinhaus; P. Rowe; J. G. van der Walt; R. Isaacs Noordien; A. Theron; B. M. Biccard

doi:10.1186/s12891-018-2062-2

BMC Musculoskeletal Disorders (May 2018)

Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study

U. Plenge,
M. B. Nortje,
L. C. Marais,
J. D. Jordaan,
R. Parker,
N. van der Westhuizen,
J. F. van der Merwe,
J. Marais,
W. V. September,
G. L. Davies,
T. Pretorius,
C. Solomon,
P. Ryan,
A. M. Torborg,
Z. Farina,
R. Smit,
C. Cairns,
H. Shanahan,
S. Sombili,
A. Mazibuko,
H. R. Hobbs,
O. S. Porrill,
N. E. Timothy,
R. E. Siebritz,
C. van der Westhuizen,
A. J. Troskie,
C. A. Blake,
L. A. Gray,
T. W. Munting,
H. K. S. Steinhaus,
P. Rowe,
J. G. van der Walt,
R. Isaacs Noordien,
A. Theron,
B. M. Biccard

Affiliations

U. Plenge: Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
M. B. Nortje: Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
L. C. Marais: Department of Orthopaedic surgery, School of Clinical Medicine, University of KwaZulu-Natal
J. D. Jordaan: Department of Orthopaedic Surgery, Tygerberg Medical School, University of Stellenbosch
R. Parker: Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
N. van der Westhuizen: Department Anaesthesia, University of the Free State
J. F. van der Merwe: Department of Orthopaedic surgery, University of the Free State
J. Marais: Department of Physiotherapy, Paarl Provincial Hospital
W. V. September: Department of Physiotherapy, Paarl Provincial Hospital
G. L. Davies: Department of Anaesthesia, Paarl Provincial Hospital
T. Pretorius: Department of Anaesthesia, Paarl Provincial Hospital
C. Solomon: Department of Orthopaedics, Paarl Provincial Hospital
P. Ryan: Arthroplasty and Sports Medicine unit, Department of Orthopaedics, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal
A. M. Torborg: Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal
Z. Farina: Department of Anaesthesia, Critical Care and Pain Management, Grey’s Hospital
R. Smit: Department of Orthopaedic surgery, Grey’s Hospital
C. Cairns: Greys Pain clinic, Department of Anaesthesia, Grey’s Hospital
H. Shanahan: Department of Physiotherapy, Grey’s Hospital
S. Sombili: Department of Orthopaedic surgery, Steve Biko Academic Hospital, University of Pretoria
A. Mazibuko: Department of Anaesthesia, Steve Biko Academic Hospital, University of Pretoria
H. R. Hobbs: Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
O. S. Porrill: Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
N. E. Timothy: Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
R. E. Siebritz: Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town
C. van der Westhuizen: Department of Anaesthesia, Worcester Hospital
A. J. Troskie: Department of Orthopaedic Surgery, Worcester Hospital
C. A. Blake: Department of Orthopaedic Surgery, Worcester Hospital
L. A. Gray: Department of Physiotherapy, New Somerset Hospital
T. W. Munting: Department of Orthopaedics, New Somerset Hospital and Christiaan Barnard Memorial Hospital
H. K. S. Steinhaus: Department of Anaesthesia, New Somerset Hospital
P. Rowe: Department of Orthopaedic surgery, Victoria Hospital
J. G. van der Walt: Department of Anaesthesia, Victoria Hospital
R. Isaacs Noordien: Department of Physiotherapy, Victoria Hospital
A. Theron: Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital, University of Stellenbosch
B. M. Biccard: Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town

DOI: https://doi.org/10.1186/s12891-018-2062-2
Journal volume & issue: Vol. 19, no. 1
pp. 1 – 6

Abstract

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Abstract Background A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.

Published in BMC Musculoskeletal Disorders

ISSN: 1471-2474 (Online)
Publisher: BMC
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: http://bmcmusculoskeletdisord.biomedcentral.com

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