Challenges in postdischarge function and recovery: the case of fast-track hip and knee arthroplasty

TY - JOUR

T1 - Challenges in postdischarge function and recovery

T2 - the case of fast-track hip and knee arthroplasty

AU - Aasvang, E K

AU - Luna, I E

AU - Kehlet, H

N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected].

PY - 2015/12/1

Y1 - 2015/12/1

N2 - This narrative review updates the recent advances in our understanding of the multifactorial pathogenesis for reduced postdischarge physical and cognitive function after fast-track surgery, using total hip and knee arthroplasty as surgical models. Relevant factors discussed include the surgical stress responses and potential methods for controlling postsurgical inflammation, pain, and cognitive dysfunction. The continuation of moderate to severe pain in up to 30% of patients for 2-4 weeks calls for better understanding of the underlying mechanisms and development of effective multimodal opioid-sparing analgesic regimens. The need for the development of effective physiotherapy programmes on a patient-specific basis is discussed, along with the need for optimal assessment of postoperative function to guide rehabilitation. Other relevant factors discussed include the role of orthostatic intolerance, sleep disturbances, and blood management, and specific patient populations at risk for adverse outcomes, including psychiatric disorders, to identify and guide future interventions for optimizing functional postdischarge outcomes after fast-track surgery.

AB - This narrative review updates the recent advances in our understanding of the multifactorial pathogenesis for reduced postdischarge physical and cognitive function after fast-track surgery, using total hip and knee arthroplasty as surgical models. Relevant factors discussed include the surgical stress responses and potential methods for controlling postsurgical inflammation, pain, and cognitive dysfunction. The continuation of moderate to severe pain in up to 30% of patients for 2-4 weeks calls for better understanding of the underlying mechanisms and development of effective multimodal opioid-sparing analgesic regimens. The need for the development of effective physiotherapy programmes on a patient-specific basis is discussed, along with the need for optimal assessment of postoperative function to guide rehabilitation. Other relevant factors discussed include the role of orthostatic intolerance, sleep disturbances, and blood management, and specific patient populations at risk for adverse outcomes, including psychiatric disorders, to identify and guide future interventions for optimizing functional postdischarge outcomes after fast-track surgery.

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Cognition Disorders

KW - Humans

KW - Length of Stay

KW - Pain, Postoperative

KW - Physical Therapy Modalities

KW - Postoperative Care

KW - Recovery of Function

KW - Systemic Inflammatory Response Syndrome

U2 - 10.1093/bja/aev257

DO - 10.1093/bja/aev257

M3 - Journal article

C2 - 26209853

SN - 0007-0912

VL - 115

SP - 861

EP - 866

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 6

ER -