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Knee. 2019 Nov 22. pii: S0968-0160(19)30232-7. doi: 10.1016/j.knee.2019.10.005. [Epub ahead of print]

Improving resource utilisation and outcomes after total knee arthroplasty through technology-enabled patient engagement.

Author information

1
Nottingham University Hospitals NHS Trust, Department of Orthopaedic Surgery, Nottingham, Nottinghamshire, UK. Electronic address: Mark.higgins2@nhs.net.
2
University of Oxford Nuffield, Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, Oxfordshire, UK; University of Texas at Austin, Dell Medical School, Department of Surgery and Perioperative Care, 421W 3rd St #1109, Austin, TX 78701, USA.
3
University of Texas at Austin, Dell Medical School, Department of Surgery and Perioperative Care, 421W 3rd St #1109, Austin, TX 78701, USA.
4
Johnson and Johnson Medical SAS, Issy-Les-Moulineaux, France.
5
Nottingham University Hospitals NHS Trust, Department of Orthopaedic Surgery, Nottingham, Nottinghamshire, UK. Electronic address: Gary.Drury@nuh.nhs.uk.
6
Nottingham University Hospitals NHS Trust, Department of Orthopaedic Surgery, Nottingham, Nottinghamshire, UK. Electronic address: apdekker@doctors.org.uk.
7
Nottingham University Hospitals NHS Trust, Department of Orthopaedic Surgery, Nottingham, Nottinghamshire, UK. Electronic address: tony.westbrook@nuh.nhs.uk.

Abstract

BACKGROUND:

A multi-modal, technology-enabled, patient engagement and pathway management solution (PES) for patients undergoing primary total knee arthroplasty (TKA) was evaluated. The primary outcome measure was length of stay (LoS). The secondary outcome measures were clinical and patient-reported outcomes (PROMs).

METHODS:

Retrospective analysis of a consecutive series of 1256 TKA patients before (n = 783) and after (n = 473) implementation of the PES. LoS, PROMs, complications, readmissions, and return to theatre were measured. Results were analysed using bivariate and multivariable regression using general linear models, and a sensitivity analysis on LoS was conducted using interrupted time series (ITS) methods.

RESULTS:

Patients in the PES cohort had a significantly shorter mean LoS of two days (mean 4.7 days) versus the Pre-PES patients (mean 6.7 days; p < 0.001) in multivariate analysis. PES was also associated with a significant reduction in rates of reoperation within 60 days compared with Pre-PES (adjusted rate 2.2% versus 5.0%, p = 0.031). There were no statistically significant differences in the 60-day complication rate and 30-day readmission rate. All PROMs in the PES cohort demonstrated significant improvement (change from baseline to six months postoperative) compared with Pre-PES (Oxford Knee Score, 20.1 versus 15.5, p < 0.001; EQ-5D Index, 0.40 versus 0.32, p = 0.005; and EQ VAS, 22.9 versus 8.3, p < 0.001).

CONCLUSIONS:

Outcomes following TKA performed in enhanced recovery programs may be improved using technology to more effectively engage patients and streamline their surgical pathway. Integration of such solutions may significantly reduce LoS and improve PROMs without negatively impacting clinical outcomes.

KEYWORDS:

Arthroplasty; Knee

PMID:
31767514
DOI:
10.1016/j.knee.2019.10.005

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