Authors (including presenting author) :
Hung YW(1); Kwok KB Carson(1); Fan Ch(1); Wan CY Raymond(1)
Wong SW(1); Lam SW Tiffany(1); Lo KM Carmen(1) Chu WS (1)
Chung KY(2)
Poon MY Carey(3); Chan CY Kazaf (3); Lau LY Doris(3)
Yeung MH Waterie( 4); Mak CH Thomas( 4); Leung HW Grace ( 4); Cheung CT Leo(4)
Affiliation :
(1)department of othopaedic and traumatology, Joint replacement centre ; AHNH (2)department of orthopaedic and traumatology, Joint replacement team; PWH
(3)department of occupation theraepy, AHNH (4)department of physiotherapy department, AHNH
Introduction :
With aging population, Joint osteoarthritis is major orthopaedic problems. From Jan 2017 to Dec 2017, 7514 new cases were booked for TJR in Hospital Authority, net increase 4115 patients (27% increase). Notional waiting time (NWT) at Dec 2017 was 5.2 years. Assuming there will be no change in demand, the projected NWT will be 10.2 years at Dec 2023. The demand is actually in rising trend. Instead of increasing investment to establish Joint Centre Among Hospital Authority. Improving Efficiency of resources usage become a very important topic. In our unit, among 70 % of our cases are Knee osteoarthritis (KOA). Yet approximately one third of knee replacement patients exhibit KOA bilaterally. Same Stage Bilateral Knee Replacement in selected patient can attain similar clinical safety, but also great cost effectiveness.
Objectives :
Since establishment of our Joint Replacement Centre (since October 2015), well design protocol and Stringent selective criteria was established. We postulated with safely selected patient for same stage bilateral knee replacement can improve efficiency of resource in term of follow outcome assessment: 1. Reduce number of pre-operative nurse clinic sessions and perioperative rehabilitation session (include physiotherapy and occupational therapy) (Relief Allied health workload)
2. Reduce bed occupancy to relieve bed crisis 3. Improve operation theatre (OT) utilization and reduce turnover time between 2 separately operation 4. Reduce cost and timing of instrument preparation for knee replacement surgery (Reduce Cost and workload from Sterilization Unit(TSSU)) 5. Significant reduce workload for follow up after operation (Relief SOPD crisis) 6. Patient Achieve same rehabilitation outcome with short period of time (Improve patient satisfactory)
Methodology :
it is retrospective review; for all cases of primary TKR done in our centre since october 2015 till dec 2017; we compare same stage bilateral TKR vs unilateral TKR in term of clinic session for doctor, nurse and allied health team;
OT cost and time post operative length of stay and comlpication patient satisfactory rate on patient journey experience
Result & Outcome :
241 and 230 patients received knee replacement in 2016 and 2017 respectively (41 bilateral vs 200 unilateral knee replacement in 2016(29% of knee) ; 53 bilateral vs 177 unilateral knee replacement in 2017(37.4% of knee)). Comparing same stage versus two stage sequential bilateral knee replacement, if each patient under-go Same-stage bilateral TKR; Following item can be save: 1: Pre-operatively: save 1 nurse preview clinic session and 1 POAC clinic, 8.7 pre-op physiotherapy session, 2: Intraoperatively: 60 minutes Operation theatre turnover time and $HK2400 for instrument preparation per cases
3: Postoperaively: 13 post-op physiotherapy session, 4.7 days length of stay
4: Patient Satisfactory: all patient feel at least satisfied to the operation journey 5: No Significant complication or readmission rate within 3 months after operation was encountered compare to unilateral TKR 6: significant reduce the rise of post operative follow up quota in SOPD by half
Co-location with:
