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

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dc.contributor.authorPlenge, U
dc.contributor.authorNortje, M B
dc.contributor.authorMarais, L C
dc.contributor.authorJordaan, J D
dc.contributor.authorParker, R
dc.contributor.authorvan der Westhuizen, N
dc.contributor.authorvan der Merwe, J F
dc.contributor.authorMarais, J
dc.contributor.authorSeptember, W V
dc.contributor.authorDavies, G L
dc.contributor.authorPretorius, T
dc.contributor.authorSolomon, C
dc.contributor.authorRyan, P
dc.contributor.authorTorborg, A M
dc.contributor.authorFarina, Z
dc.contributor.authorSmit, R
dc.contributor.authorCairns, C
dc.contributor.authorShanahan, H
dc.contributor.authorSombili, S
dc.contributor.authorMazibuko, A
dc.contributor.authorHobbs, H R
dc.contributor.authorPorrill, O S
dc.contributor.authorTimothy, N E
dc.contributor.authorSiebritz, R E
dc.contributor.authorvan der Westhuizen, C
dc.contributor.authorTroskie, A J
dc.contributor.authorBlake, C A
dc.contributor.authorGray, L A
dc.contributor.authorMunting, T W
dc.contributor.authorSteinhaus, H K S
dc.contributor.authorRowe, P
dc.contributor.authorvan der Walt, J G
dc.contributor.authorIsaacs Noordien, R
dc.contributor.authorTheron, A
dc.contributor.authorBiccard, B M
dc.date.accessioned2018-05-14T09:19:15Z
dc.date.available2018-05-14T09:19:15Z
dc.date.issued2018-05-09
dc.date.updated2018-05-13T03:29:08Z
dc.description.abstractBackground 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.
dc.identifier.apacitationPlenge, U., Nortje, M. B., Marais, L. C., Jordaan, J. D., Parker, R., van der Westhuizen, N., ... Biccard, B. M. (2018). Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study. <i>BMC Musculoskeletal Disorders</i>, http://hdl.handle.net/11427/28045en_ZA
dc.identifier.chicagocitationPlenge, U, M B Nortje, L C Marais, J D Jordaan, R Parker, N van der Westhuizen, J F van der Merwe, et al "Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study." <i>BMC Musculoskeletal Disorders</i> (2018) http://hdl.handle.net/11427/28045en_ZA
dc.identifier.citationBMC Musculoskeletal Disorders. 2018 May 09;19(1):140
dc.identifier.ris TY - Journal Article AU - Plenge, U AU - Nortje, M B AU - Marais, L C AU - Jordaan, J D AU - Parker, R AU - van der Westhuizen, N AU - van der Merwe, J F AU - Marais, J AU - September, W V AU - Davies, G L AU - Pretorius, T AU - Solomon, C AU - Ryan, P AU - Torborg, A M AU - Farina, Z AU - Smit, R AU - Cairns, C AU - Shanahan, H AU - Sombili, S AU - Mazibuko, A AU - Hobbs, H R AU - Porrill, O S AU - Timothy, N E AU - Siebritz, R E AU - van der Westhuizen, C AU - Troskie, A J AU - Blake, C A AU - Gray, L A AU - Munting, T W AU - Steinhaus, H K S AU - Rowe, P AU - van der Walt, J G AU - Isaacs Noordien, R AU - Theron, A AU - Biccard, B M AB - 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. DA - 2018-05-09 DB - OpenUCT DP - University of Cape Town J1 - BMC Musculoskeletal Disorders LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study TI - Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study UR - http://hdl.handle.net/11427/28045 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12891-018-2062-2
dc.identifier.urihttp://hdl.handle.net/11427/28045
dc.identifier.vancouvercitationPlenge U, Nortje MB, Marais LC, Jordaan JD, Parker R, van der Westhuizen N, et al. Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study. BMC Musculoskeletal Disorders. 2018; http://hdl.handle.net/11427/28045.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDepartment of Anaesthesiaen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Musculoskeletal Disorders
dc.source.urihttps://bmcmusculoskeletdisord.biomedcentral.com/
dc.subject.otherDelphi study
dc.subject.otherEnhanced recovery pathways
dc.subject.otherLow middle income countries
dc.subject.otherTotal hip and knee arthroplasty
dc.subject.otherTotal hip and knee replacement
dc.subject.otherPatient outcomes
dc.titleOptimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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