Key result
The new perioperative practice model did not shorten the length of hospital stay compared to standard care in patients undergoing total hip and knee arthroplasty.
Why the study?
Shortened hospital stays require efficient perioperative nursing approaches, prompting evaluation of whether a new practice model improves length of stay and surgical care timelines in arthroplasty.
Does a new perioperative practice model reduce length of hospital stay in patients undergoing hip and knee arthroplasty?
RCT (n=450)
Single-blind
Two-group parallel
No
Does a new perioperative practice model reduce length of hospital stay in patients undergoing hip and knee arthroplasty?
A new perioperative practice model providing continuity of care by a single anesthesia nurse did not significantly reduce length of hospital stay for patients undergoing hip or knee arthroplasty compared to standard care.
Answers are grounded in this paper and cite their sources.
Does not support adopting the new model to shorten stays; confirms null effect on length of stay in hip/knee arthroplasty.
BACKGROUND: The shortened length of hospital stays (LOS) requires efficient and patient-participatory perioperative nursing approaches to enable early and safe discharge from hospitals for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The primary aim of this study was to explore the effect comparative to standard perioperative care of a new perioperative practice model (NPPM) on the LOS and the time points of the surgical care process in patients undergoing THA and TKA under spinal anesthesia. The secondary aim was to find out if any subgroups with different response could be found. METHODS: = 220), totaling 450 patients. The patients in the intervention group were each designated with one named anesthesia nurse, who took care of the patient during the entire perioperative process and visited the patient postoperatively. The patients in the control group received standard perioperative care from different nurses during their perioperative processes and without postoperative visits. The surgical care process time points for each study patient were gathered from the operating room management software and hospital information system until hospital discharge. RESULTS: We did not find any statistically significant differences between the intervention and control groups regarding to LOS. Only slight differences in the time points of the surgical care process could be detected. The subgroup examination revealed that higher age, type of arthroplasty and ASA score 3-4 all separately caused prolonged LOS. CONCLUSION: We did not find the new perioperative practice model to shorten either length of hospital stays or the surgical care process in patients undergoing THA and TKA. Further studies at the subgroup level (gender, old age, and ASA score 3 and 4) are needed to recognize the patients who might benefit most from the NPPM. TRIAL REGISTRATION: This study was registered in NIH Clinical.Trials.gov under registration number NCT02906033, retrospectively registered September 19, 2016.
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Pulkkinen et al. (2020) conducted an RCT in Total hip arthroplasty (THA) and total knee arthroplasty (TKA) (n=450). New perioperative practice model (NPPM) vs. Standard perioperative care was evaluated on Length of hospital stay (LOS) in days (MD -0.10, 95% CI -0.40, 0.19, p=0.49). The new perioperative practice model did not shorten the length of hospital stay compared to standard care in patients undergoing total hip and knee arthroplasty.
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