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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims LEAP (Leicester Enhanced Arthroplasty Pathway) was initiated in accordance with the GIRFT (Getting It Right First Time - NHS improvement programme) standards aiming to expedite the recovery from elective hip and knee arthroplasty without compromising safety.
Methods The LEAP provides a perioperative care standardised pathway for patients undergoing elective hip and knee replacements. There are certain steps to be followed in the preoperative period which includes optimization of co-morbidities and careful patient selection given a vast number of our patients are in the ASA3 category. Intra operative measures are aimed at minimizing post operative side effects and promoting rapid early mobilization. The anaesthetic itself involves an opioid-free spinal using either heavy 2% prilocaine, low-dose 0.5% heavy bupivacaine or 0.5% levobupivacaine depending on the expected duration of surgery. Multimodal analgesia comprises of intraoperative IV Paracetamol, PR Diclofenac or IV Parecoxib and high dose Dexamethasone (9.9-13.2mg) administration unless contraindicated. The only nerve block performed is an ultrasound-guided adductor canal block for all knee replacements. Post-operatively, patients receive regular Paracetamol, Naproxen, Codeine Phosphate and Oramorph as required. Nefopam is prescribed for patients who are intolerant to NSAIDS or opiates.
Results Since the introduction of LEAP, there has been a significant reduction in the length of stay following elective primary hip and knee arthroplasty surgery (Image 1, 2,3).
Conclusions A multidisciplinary approach incorporating simple yet effective measures has contributed to a significant reduction in the length of stay for patients undergoing hip and knee arthroplasty surgery.
Average length of stay for hip replacements since the introduction of LEAP
Average length of stay for knee replacements since the introduction of LEAP
Average length of stay for combined hip and knee replacements since the introduction of LEAP