ARTHROPLASTY
Telemedicine support shortens length of stay after fast-track hip replacement
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by one or more authors of the
original publication.
Este estudio ha sido identificado como potencialmente de alto impacto.
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Desarrollado mediante el procesamiento del lenguaje natural más avanzado, el modelo de Alto Impacto de OE predice con mayor precisión el futuro rendimiento de las citas de un estudio que el factor de impacto de la revista por sí solo.
Esto permite reconocer antes las investigaciones clínicamente significativas y ayuda a los lectores a centrarse en los artículos con más probabilidades de configurar la práctica futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2017;5(18):1 Acta Orthop. 2017 Feb;88(1):41-4773 patients scheduled for fast-track total hip arthroplasty were randomized to a telemedicine intervention for use after scheduled discharge on postoperative day one, or to a standard pathway with training and rehabilitation on postoperative day one, and discharge on postoperative day two. Patients were assessed for mean length of stay, health-related quality-of-life, function, and readmission rate. Results demonstrated a significantly shorter length of stay in the telemedicine group compared to the control group. Health-related quality-of-life, function, and readmission rate over the 12-month follow-up were similar between groups
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
2/4
Randomização
2/4
Medições dos resultados
3/4
Inclusão / Exclusão
3/4
Descrição da terapia
4/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
The number of total hip arthroplasty procedures performed per year is expected to increase with the aging population. This has placed pressure on health care systems to improve efficiency, making fast-track procedures an attractive option. While some trials have demonstrated the efficacy of fast-track techniques the addition of telemedicine during the early postoperative period could allow for earlier discharge from the hospital. However, the effect of earlier discharge and the addition of telehealth medicine on quality of life outcomes and safety has yet to be assessed in rigorous clinical trials.
¿Cuál era la pregunta principal de la investigación?
In fast-track total hip arthroplasty, does a telemedicine intervention have a significant effect on length of stay, health-related quality-of-life, function, anxiety, or re-admission rate when compared to a standard fast-track postoperative program?
¿Cuáles fueron los hallazgos importantes?
- Length of stay was significantly shorter in the telemedicine group compared to the control group (MD; -0.72 days [95%CI -1.02, -0.42]; p<0.001).
- Discharge home on the first postoperative day occurred in 34/36 patients of the telemedicine group. Discharge home on the first postoperative day occurred in 8/36 in the control group, and on the second postoperative day in 26/36 day.
- There was no significant difference in change in EQ-5D-3L scores after 12 months between groups (MD -0.01 [95%CI -0.063, 0.036]; p=0.6).
- There was no significant difference between groups in change in OHS after 12 months (MD 0.39 [95%CI -2.1, 2.9]; p=0.8), or change in TUG test results after 12 months (MD 0.6 seconds [95%CI -0.05, 1.26]; p=0.07).
- There were no significant differences between groups in the number of extra visits to the hospital (p=0.4) or in the number of readmissions (p=0.3). There were significantly fewer calls placed among patients of the telemedicine (0.92 [95%CI 0.56-0.73]) compared to the control group (1.5 [95%CI 1.1-1.9]) (p=0.04).
¿Qué es lo que más debo recordar?
In patients undergoing fast-track total hip arthroplasty, the implementation of a telemedicine system allowed for a higher rate of patients discharged on the first postoperative day when compared to a standard postoperative program with training and rehabilitation on the first postoperative day. Similar improvements in health-related quality-of-life, function, and anxiety were noted over the 12-month follow-up.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study suggest that the implementation of a telemedicine could be beneficial in fast-track total hip arthroplasty pathways to allow for earlier discharge, along with similar quality-of-life and functional outcome to that achieved by a standard fast-track pathway which use the first postoperative day to implement training of rehabilitation prior to discharge.
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