title: The efficiency of the patient care team on 3-day protocol for early ambulation after MIS-TKA.
abstract: OBJECTIVE
  To evaluate the efficiency of the patient care team on the 3-day protocol for early ambulation after minimally invasive surgery-total knee arthroplasty (MIS-TKA) MATERIAL AND METHOD: A consecutive series of 120 episodes of patient's admission for MIS-TKA in 103 patients, who were taken care of by a single patient care team, was included in the present study. A uniform multimodal pain management and a 3-day rehabilitation protocol were applied. Patient's demographic data, co-morbidities, pre- and postoperative pain, and patient's voluntary early ambulation following the 3-day protocol were evaluated. Patients who accomplished the 3-day protocol were defined as having progress in postoperative ambulation, ability to do basic activities of daily living (ADL) and able to comfortably walk on postoperative day 3 (POD 3).
  
  
  RESULTS
  Patient's mean age was 67.5 years and 68% (70/103) of patients had medical co-morbidities. After surgery, serial mean pain scores from six hours to the day of discharge in the studied group were < 3. The 3-day protocol had an overall success rate of 89% (107/120) regardless of medical co-morbidities. However 32% of cases that had accomplished this protocol extended hospital stay due to non-medical reasons. Among 13 patients who were unable to accomplish the 3-day protocol, higher rate was found in patients who had > 1 medical co-morbidities. Comparing between unsuccessful and successful groups, there was a significantly increasing rate of unsuccessful protocol in patients who had > 1 medical comorbidities (69.2% vs. 31.8%; p, < 0.05). There was no complication or readmission related to the early discharge program.
  
  
  CONCLUSIONS
  The result of 3-day protocol handled by the patient care team for MIS-TKA was highly efficient without complications related to early ambulation. However, this early ambulation protocol may not be appropriate for patients who have multiple medical co-morbidities. Besides the role of the patient care team, the efficiency of postoperative ambulation protocol was additionally relied on surgeon's experience in the surgical technique and effective multimodal postoperative pain control.
authors.affiliation: Nursing Department, Saint Louis Hospital, Bangkok, Thailand. ** Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. pornkhun@gmail.com
authors.forename: Pornchanok
authors.initials: P
authors.lastname: Nophakhun
authors.forename: Atchara
authors.initials: A
authors.lastname: Yindee
authors.forename: Piangduan
authors.initials: P
authors.lastname: Amornpiyakij
authors.forename: Nipaporn
authors.initials: N
authors.lastname: Hlekmon
authors.forename: Aree
authors.initials: A
authors.lastname: Tanavalee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000503:physiopathology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee; D002985:Clinical Protocols; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome