1. Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study
- Author
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Ripolles-Melchor, Javier, Aldecoa, Cesar, Fernandez-Garcia, Raquel, Varela-Duran, Marina, Aracil-Escoda, Norma, Garcia-Rodriguez, Daniel, Cabezudo-de-la-Muela, Lucia, Hormaechea-Bolado, Lucia, Nacarino-Alcorta, Beatriz, Hoffmann, Rolf, Lorente, Juan, V, Ramirez-Rodriguez, Jose M., Abad-Motos, Ane, Spanish Perioperative Audit Res, [Ripolles-Melchor, Javier] Infanta Leonor Univ Hosp, Dept Anesthesia & Perioperat Med, Madrid, Spain, [Aracil-Escoda, Norma] Infanta Leonor Univ Hosp, Dept Anesthesia & Perioperat Med, Madrid, Spain, [Abad-Motos, Ane] Infanta Leonor Univ Hosp, Dept Anesthesia & Perioperat Med, Madrid, Spain, [Ripolles-Melchor, Javier] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain, [Aldecoa, Cesar] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain, [Ramirez-Rodriguez, Jose M.] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain, [Abad-Motos, Ane] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain, [Ripolles-Melchor, Javier] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Aldecoa, Cesar] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Fernandez-Garcia, Raquel] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Varela-Duran, Marina] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Aracil-Escoda, Norma] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Garcia-Rodriguez, Daniel] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Cabezudo-de-la-Muela, Lucia] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Hormaechea-Bolado, Lucia] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Nacarino-Alcorta, Beatriz] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Hoffmann, Rolf] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Lorente, Juan, V] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Ramirez-Rodriguez, Jose M.] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Abad-Motos, Ane] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain, [Ripolles-Melchor, Javier] Rio Hortega Univ Hosp, Dept Anesthesia & Crit Care, Valladolid, Spain, [Aldecoa, Cesar] Rio Hortega Univ Hosp, Dept Anesthesia & Crit Care, Valladolid, Spain, [Abad-Motos, Ane] Rio Hortega Univ Hosp, Dept Anesthesia & Crit Care, Valladolid, Spain, [Fernandez-Garcia, Raquel] Mostoles Univ Hosp, Dept Anesthesia & Crit Care, Mostoles, Spain, [Nacarino-Alcorta, Beatriz] Mostoles Univ Hosp, Dept Anesthesia & Crit Care, Mostoles, Spain, [Varela-Duran, Marina] Complexo Hosp Montecelo, Dept Anesthesia & Crit Care, Pontevedra, Spain, [Garcia-Rodriguez, Daniel] Hosp La Cruz Roja, Dept Anesthesia & Perioperat Med, Gijon, Spain, [Cabezudo-de-la-Muela, Lucia] La Fe Univ Hosp, Dept Anesthesia & Perioperat Med, Valencia, Spain, [Hormaechea-Bolado, Lucia] Puerta de Hierro Univ Hosp, Dept Anesthesia & Perioperat Med, Majadahonda, Spain, [Hoffmann, Rolf] Hosp Santa Creu & Sant Pau, Dept Anesthesia & Perioperat Med, Barcelona, Spain, [Lorente, Juan, V] Juan Ramon Jimenez Univ Hosp, Dept Anesthesia & Perioperat Med, Huelva, Spain, and [Ramirez-Rodriguez, Jose M.] Lozano Blesa Univ Hosp, Dept Surg, Zaragoza, Spain
- Subjects
Local anesthesia ,medicine.medical_specialty ,Efficacy ,medicine.medical_treatment ,Replacement ,Total knee arthroplasty ,Medicine ,Prospective cohort study ,Enhanced recovery ,Enhanced Recovery After Surgery (ERAS) ,Mobilization ,business.industry ,General Medicine ,Perioperative ,Arthroplasty ,Early mobilization ,Confidence interval ,Fast-track hip ,Surgery ,Management ,Total joint arthroplasty ,Total hip arthroplasty ,Statement ,business ,Preoperative anemia ,Length-of-stay - Abstract
Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16–30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72–0.90); p = 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55–0.60); p < 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92–0.93); p < 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96–0.98); p < 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.
- Published
- 2021