The efficiency of the patient care team on 3-day protocol for early ambulation after MIS-TKA
Nophakhun, P.; Yindee, A.; Amornpiyakij, P.; Hlekmon, N.; Tanavalee, A.
Journal of the Medical Association of Thailand 95(4): 537-543
2012
ISSN/ISBN: 0125-2208 PMID: 22612008 Document Number: 15390
To evaluate the efficiency of the patient care team on the 3-day protocol for early ambulation after minimally invasive surgery-total knee arthroplasty (MIS-TKA) MATERIAL AND METHOD: A consecutive series of 120 episodes of patient's admission for MIS-TKA in 103 patients, who were taken care of by a single patient care team, was included in the present study. A uniform multimodal pain management and a 3-day rehabilitation protocol were applied. Patient's demographic data, co-morbidities, pre- and postoperative pain, and patient's voluntary early ambulation following the 3-day protocol were evaluated. Patients who accomplished the 3-day protocol were defined as having progress in postoperative ambulation, ability to do basic activities of daily living (ADL) and able to comfortably walk on postoperative day 3 (POD 3). Patient's mean age was 67.5 years and 68% (70/103) of patients had medical co-morbidities. After surgery, serial mean pain scores from six hours to the day of discharge in the studied group were < 3. The 3-day protocol had an overall success rate of 89% (107/120) regardless of medical co-morbidities. However 32% of cases that had accomplished this protocol extended hospital stay due to non-medical reasons. Among 13 patients who were unable to accomplish the 3-day protocol, higher rate was found in patients who had > 1 medical co-morbidities. Comparing between unsuccessful and successful groups, there was a significantly increasing rate of unsuccessful protocol in patients who had > 1 medical comorbidities (69.2% vs. 31.8%; p, < 0.05). There was no complication or readmission related to the early discharge program. The result of 3-day protocol handled by the patient care team for MIS-TKA was highly efficient without complications related to early ambulation. However, this early ambulation protocol may not be appropriate for patients who have multiple medical co-morbidities. Besides the role of the patient care team, the efficiency of postoperative ambulation protocol was additionally relied on surgeon's experience in the surgical technique and effective multimodal postoperative pain control.
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