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van CCT (UK)

van CCT (UK)

Efficiency and safety of care pathways for knee and hip arthroplasty

- candidate number24474
- NTR NumberNTR5923
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR13-jun-2016
- Secondary IDsMETC: 16N103 
- Public TitleEfficiency and safety of care pathways for knee and hip arthroplasty
- Scientific TitleEfficiency and safety of care pathways for knee and hip arthroplasty: a systematic review with meta-analysis
- hypothesisNumbers of hip and knee arthroplasties are increasing worldwide. The optimization of the treatment and the scientifically supported procedures are implemented in clinical pathways (CPs). CPs have developed during the past decades and this systematic review (SR) with planned meta-analysis (MA) evaluates the efficiency and safety of various care pathways for knee and hip arthroplasty.
- Healt Condition(s) or Problem(s) studiedKnee, Hip, Arthropathy
- Inclusion criteria• Studies including patients of 18 years or older undergoing implantation of a hip or knee prosthesis;
• Studies which compare the intervention with standard care.
- Exclusion criteria• Studies including patients undergoing revision arthroplasty;
• Strictly descriptive articles, e.g. historical articles.
- mec approval receivedyes
- multicenter trialno
- randomisedno
- groupParallel
- Type2 or more arms, randomized
- Studytypeobservational
- planned startdate 1-jul-2016
- planned closingdate1-okt-2016
- Target number of participants0
- InterventionsThe general objective is to perform a systematic review and to summarize the available literature regarding the efficiency and safety of clinical pathways for patients undergoing knee or hip arthroplasty.
- Primary outcomePrimary Objective: To identify the most efficient and safe clinical pathways for knee and hip arthroplasty
- Secondary outcomeSecondary Objective(s): Do CPs for hip and knee arthroplasty provide financial benefit? Costs are only included if they are listed properly and carefully. Also other postoperative complications, relevant to the question, will be summarized.
- Timepointsn.a.
- Trial web site
- statusopen: patient inclusion
- Sponsor/Initiator Zuyderland Medical Center, Heerlen
- Funding
(Source(s) of Monetary or Material Support)
- Publications
- Brief summaryWhile the number of these surgeries worldwide is increasing, CPs have been developed to improve efficiency and decrease hospital stay3,6,14 The LOS depends apart from the clinical outcome and patients’ comorbidity, on social and marital status and cultural aspects. Even the health insurances may have influence.3 The LOS has reduced significantly by the use of CPs.13 Nowadays, an outpatient surgery (OS) pathway with possible discharge on the day of surgery has been developed reducing the LOS to one day.7,14 With the OS the patient stays in the hospital for one day only; it is a day care surgery with a day procedure, a patients-specific approach, an optimized process in which the proactive patient is essential. Admission and discharge are on the day of surgery, without an overnight hospital stay.11 This reduction of LOS might satisfy the patient 7,14 as he is able to return home on the same day.

Therefore, the effects of CPs and the decreasing LOS in terms of (serious) adverse events ((S)AE), readmission, functional recovery and PROMS have to be investigated. It should also take into account the long waiting lists and the increasing economic burden on the public health system
- Main changes (audit trail)
- RECORD13-jun-2016 - 8-aug-2016

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