Article

Over the last 5 years, there has been increasing interest
in reducing length of hospitalization (LOS) through accelerated programs. We
examined the clinical outcome of patients undergoing a unicompartmental knee
replacement (UKR) in an accelerated care program (A group) compared to a
conventional care program (C group). METHODS:
40 patients randomized into 2
groups were included (A group: 17 patients; C group: 23 patients). Nausea,
micturition problems, lower limb dysfunction, pain (VAS), opiate consumption,
Knee Society score (KSS), day of discharge, rehospitalization within 3 months,
contact with a general physician or nurse, and level of satisfaction were
registered. Patients in the A group attended an information meeting. An
intraarticular infiltration with Marcaine and adrenaline was used peroperatively.
Patients in the C group had an epidural pump for 2 or 3 days. Patients in the A
program were treated with NSAID and paracetamol postoperatively. Opiates were
used in both groups in the case of breakthrough pain. The patients were
considered ready for discharge when they were able to climb stairs to the second
floor within 5 min. RESULTS: The median length of stay was 1 (1-3) day in the A
group and 6 (4-7) days in the C group. The median pain score (VAS) at day 0 was 1
(0-3) in the A group and 5 (0-8) in the C group (p < 0.001). 11/23 of the
patients in the C group had weakness of the lower limbs on day 1 due to the
epidural; all patients in the A group were exercising on the day of the
operation. Micturition problems necessitating intermediate catherization were
more frequent in patients in the C program (19/23) than in patients in the A
programme (3/17) (p = 0.001). There were no statistically significant differences
between the two groups concerning nausea, average pain on days 1 and 2, use of
opioids (during the first week postoperatively), KSS, contact with primary
sector, level of satisfaction, or level of confidence. INTERPRETATION: We
achieved a reduction in LOS of 5 days without affecting the clinical outcome.

Langue : ANGLAIS