Page 215 - HA Convention 2016 [Full Version]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F6.1 Managing Service Demands 10:45 Room 421

Effectiveness of Fast-track Arthroplasty Programme to Enhance Recovery through Multidisciplinary

Collaboration
Chan PK1, Chiu KY 1, Chan CW 2, Chung YF 2, Wong NY 3, Ng J 3, Fung YK 6, Shiu KW 6, Yeung SS 7, Ng YL 8, Chan MT 5, Lam R 4,
Yip HT4, Ng FY 1, Yan CH 1, Fu CH 1
1Department of Orthopaedics and Traumatology, Queen Mary Hospital, 2Department of Anaesthesiology, Queen Mary
Hospital, 3Department of Nursing, Queen Mary Hospital, 4Department of Physiotherapy, Queen Mary Hospital, 5Department of
Occupational Therapy, Queen Mary Hospital, 6 Nursing Department, MacLehose Medical Rehabilitation Centre, 7Department
of Physiotherapy, MacLehose Medical Rehabilitation Centre, 8Department of Occupational Therapy, MacLehose Medical

Rehabilitation Centre, Hong Kong

Introduction Wednesday, 4 May

With an aging population in Hong Kong, there will be an increasing healthcare demand for the management of osteoarthritis
of knee. Total knee arthroplasty (TKA) is the treatment of choice for patients unresponsive to conservative management. Due
to limited healthcare budget, measures in improving clinical efficiency are very important. Fast-track Arthroplasty (FTA), which
was widely adopted in Europe, was shown to result in quicker functional recovery, decreased length of convalescence, and
reduced hospital costs after TKA. Since May 2013, the traditional rehabilitation plan after TKA in our institution was modified
after reviewing the updated literature, learning from invited overseas expert and with HA’s support on overseas training.
At present, FTA programme included comprehensive nurse-led multidisciplinary pre-operative education, pre-operative
assessment by physiotherapists and occupational therapists on physical aspects and home-readiness respectively, modern
surgical and anaesthetic techniques to limit stress response from surgery and to enhance recovery, effective post-operative
pain control measures and early rehabilitation training after surgery.

Objectives

To review clinical outcome of the FTA programme.

Methodology

It was a case-control study. The control group were patients with TKA done according to traditional protocol in our institution
in 2012, whereas the case group were patients with TKA done according to updated FTA programme in our institution in
2015. Patient’s demographics and average length of stay (LOS), 90-day readmission rate, and pre-operative and post-
operative knee functions at sixth week (Knee Society Functional Score) was compared between 2012 and 2015. The data
were collected from Clinical Data Analysis and Reporting System (CDARS), local joint registry database.The result was taken
as significant if p<0.05.

Results

There were 266 patients and 318 patients with primary TKA done in our institution in 2012 and 2015 respectively. Both
groups of patients were comparable in sex, age and preoperative knee function (p >0.05). The average LOS was statistically
significant decreased after FTA programme (19.2 day in 2012 Vs 12.3 day in 2015, p<0.05). The 90-day readmission rate (11.2%
in 2012 Vs 10.8% in 2015, p=0.75), and the post-operative knee function at sixth week showed no significant difference
(p>0.05).

Conclusions

Through multidisciplinary collaboration, FTA programme was effective in reducing LOS after TKA in our institution. There was
no associated increase in readmission rate, or inferior rehabilitation outcome. To improve clinical efficiency in managing age-
related degenerative conditions in Hong Kong, fast-track principles need to be considered in current surgical practice.

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