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

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dc.contributor.author Plenge, U.
dc.contributor.author Nortje, M.B.
dc.contributor.author Marais, L.C.
dc.contributor.author Jordaan, J.D.
dc.contributor.author Parker, R.
dc.contributor.author Van der Westhuizen, N.
dc.contributor.author Van der Merwe, J.F.
dc.contributor.author Marais, J.
dc.contributor.author September, W.V.
dc.contributor.author Davies, G.L.
dc.contributor.author Pretorius, T.
dc.contributor.author Solomon, C.
dc.contributor.author Ryan, P.
dc.contributor.author Torborg, A.M.
dc.contributor.author Farina, Z.
dc.contributor.author Smit, R.
dc.contributor.author Cairns, C.
dc.contributor.author Shanahan, H.
dc.contributor.author Sombili, Simon
dc.contributor.author Mazibuko, A.N. (Andile)
dc.contributor.author Hobbs, H.R.
dc.contributor.author Porrill, O.S.
dc.contributor.author Timothy, N.E.
dc.contributor.author Siebritz, R.E.
dc.contributor.author Van der Westhuizen, C.
dc.contributor.author Troskie, A.J.
dc.contributor.author Blake, C.A.
dc.contributor.author Gray, L.A.
dc.contributor.author Munting, T.W.
dc.contributor.author Steinhaus, H.K.S.
dc.contributor.author Rowe, P.
dc.contributor.author Van der Walt, J.G.
dc.contributor.author Noordien, R. Isaacs
dc.contributor.author Theron, A.
dc.contributor.author Biccard, B.M.
dc.date.accessioned 2018-09-07T09:56:27Z
dc.date.available 2018-09-07T09:56:27Z
dc.date.issued 2018-05-09
dc.description.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. en_ZA
dc.description.department Anaesthesiology en_ZA
dc.description.department Orthopaedic Surgery en_ZA
dc.description.librarian am2018 en_ZA
dc.description.uri https://bmcmusculoskeletdisord.biomedcentral.com en_ZA
dc.identifier.citation Plenge, U., Nortje, M.B., Marais, L.C. et al. 2018, 'Optimising perioperative care for hip and knee arthroplasty in South Africa : a Delphi consensus study', BMC Musculoskeletal Disorders, vol. 19, art. no. 140, pp. 1-6. en_ZA
dc.identifier.issn 1471-2474 (online)
dc.identifier.other 10.1186/s12891-018-2062-2
dc.identifier.uri http://hdl.handle.net/2263/66479
dc.language.iso en en_ZA
dc.publisher BioMed Central en_ZA
dc.rights © The Author(s). 2018. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/). en_ZA
dc.subject Delphi study en_ZA
dc.subject Enhanced recovery pathways en_ZA
dc.subject Total hip and knee arthroplasty en_ZA
dc.subject Total hip and knee replacement en_ZA
dc.subject Patient outcomes en_ZA
dc.subject Low- and middle-income countries (LMICs) en_ZA
dc.subject Enhanced recovery en_ZA
dc.subject Surgery outcomes en_ZA
dc.title Optimising perioperative care for hip and knee arthroplasty in South Africa : a Delphi consensus study en_ZA
dc.type Article en_ZA


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