RT info:eu-repo/semantics/doctoralThesis T1 Manejo perioperatorio óptimo en pacientes sometidos a artroplastia de miembro inferior: conclusiones del análisis POWER 2 A1 Abad Motos, Ane A2 Universidad de Valladolid. Escuela de Doctorado K1 Cirugía K1 Orthopedic surgery K1 Cirugía ortopédica K1 Enhanced recovery K1 Recuperación intensificada K1 Postoperative complications K1 Complicaciones postoperatorias K1 Anemia K1 Anemia K1 32 Ciencias Médicas AB Background: total hip and knee replacement surgeries are relatively safe, but their volume represents a high consumption of resources. Accelerated recovery or ERAS protocols attempt to improve outcomes by speeding recovery and decreasing complications.Material and methods: national multicenter prospective observational study, in which hospitals were invited to participate regardless of the existence of an ERAS protocol. During a single 2-month recruitment period in 2018, all adult patients undergoing total hip or knee arthroplasty were included, with a 30-day follow-up. The primary objectives were the association of adherence to ERAS protocols with postoperative complications; to determine the time until mobilization after surgery, and to identify the preoperative hemoglobin level associated with a lower incidence of complications. The secondary objectives were to determine the association between adherence to ERAS protocols and length of stay, readmissions, and mortality; to identify factors associated with early mobilization, and to determine the relationship between preoperative anemia and blood transfusion, readmissions, hospital stay and mortality.Results: 6146 patients were included (3580 women (58.2%); median age 71 [IQR 63 – 76] years). Of these, 680 (11.1%) presented postoperative complications. The entire cohort was divided into quartiles according to adherence to the individual ERAS elements regardless of the center where they had undergone surgery. Patients in the quartile with the highest adherence had a lower number of total postoperative complications (144 (10.6%) vs. 270 (13.0%); OR 0.80; 95% CI 0.64-0.99; P < 0.001 ), moderate or severe complications (59 (4.4%) vs 143 (6.9%); OR 0.62; 95% CI 0.45-0.84; P< 0.001) and a shorter hospital lenght of stay (4 [IQR 3-5] versus 5 [IQR 4-6] days; OR 0.97; 95% CI 0.96-0.99; P< 0.001) compared to the lowest adherence quartile.The median time to achieve mobilization after surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved ≤ 24 hours after surgery. Infiltrative local anesthesia (OR = 0.80; 95% CI 0.72-0.90; P = 0.001), surgery in a self-declared ERAS center (OR = 0.57; 95% CI 0.55- 0.60; P <0.001), mean adherence to ERAS elements (OR = 0.93; 95% CI 0.92-0.93; P <0.001) and preoperative hemoglobin (OR = 0.97; CI 0.96-0.98; P<0.001) were associated with a shorter time to mobilization.8.8% of patients were anemic. Patients with preoperative anemia were more likely to have postoperative complications (111/539 (20.6%) vs 563/5560 (10.1%), P<0.001), and moderate or severe complications (67/539 (12.4%) vs 284/5560 (5.1%), P<0.001). Multivariate analysis showed that preoperative hemoglobin ≥14 g/dl was associated with fewer postoperative complications.Conclusions: Greater compliance with the ERAS elements was associated with a decrease in complications and length of stay. The elements associated with less complications were a preoperative Hb, the use of tranexamic acid, less bleeding and early mobilization. The majority of patients were mobilized in the first 24 hours after surgery. Early mobilization was associated with adherence to the protocol, preoperative hemoglobin, use of infiltrative local anesthesia (LIA), absence of urinary catheter, surgical drains or epidural catheter, and postoperative complications. A preoperative hemoglobin ≥ 14 g/dL was associated with a lower risk of postoperative complications. Preoperative anemia was associated with a higher likelihood of receiving blood transfusions, longer length of hospital stay, and increased readmissions. YR 2024 FD 2024 LK https://uvadoc.uva.es/handle/10324/66912 UL https://uvadoc.uva.es/handle/10324/66912 LA spa NO Escuela de Doctorado DS UVaDOC RD 22-nov-2024