Our Accelerated Care Pathway Program

Improving your outcome , recover more quickly

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

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