Our Accelerated Care Pathway Program

Definition of our Accelerated Care Program

 Since 2018 I have adopted a multimodal perioperative care program in Paarl that aims to allow patients to recover more quickly and better after major joint replacement procedures.

Elements of the program

Preoperative teaching and support

• Optimization of the patient’s condition before the operation
• Stop smoking 4 weeks before the operation
• Stop alcohol intake before the operation
• Diagnosis and treatment of preoperative anemia
• Clear moisture can be ingested up to 2 hours before the operation
• Solid foods must be stopped for 6 hours before the operation

Spinal anesthesia rather than a general anesthesia or epidural anesthesia

• Avoidance of intra spinal opioids (morphine)
• Use of local anesthetic injections in the wound area
• Routine use of emetics to prevent nausea and vomiting
• The use of Transexamic acid injections to limit blood loss

Simultaneous use of different types of painkillers:

• Paracetamol
• Anti-inflammatory products
• Gabapentoids
• Opioids especially shortly after surgery and for worse pain

Keep the patient’s body temperature normal during the operation

Preventive high dose intravenous antibiotic treatment

• The use of antibiotic-laden bone cement

The use of various modalities to prevent blood clots

• Blood thinning medication
• Early (same day) mobilization
• Mechanical aids

Perioperative surgical factors

• Limited use of a tournament
• Limited use of wound drainage
• Limited use of a urinary catheter
• Optimal perioperative fluid balance
• Perioperative glycaemic control
• Early resumption of a normal eating pattern

Criteria based discharge from the hospital:

• Ability to dress yourself
• Ability to get out of the bed
• Ability to get up from a chair unaided
• Independence with personal care
• Independent mobilization with crutches or a walking frame
• The ability to walk more than 70 meters with crutches

The measurement of clinical outcomes

The measurement of non-clinical outcomes

• Costs of the event
• Patient experience
• Patient satisfaction
• Measurement of deviations from the protocol
• Adaptation of the protocol as new evidence emerges

Advantages of the Accelerated Care Plan 

• It reduces surgical trauma and the stress response
• It improves the outcomes of major operations
• It reduces the length of stay in the hospital
• It reduces postoperative morbidity
• It is more cost effective