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Prästationäres Management in der Fast-Track-Endoprothetik

Preoperative management in fast-track arthroplasty

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Zusammenfassung

Hintergrund

Das prästationäre Management ist in der Fast-Track-Endoprothetik von elementarer Bedeutung und umfasst eine umfangreiche Aufklärung des Patienten und eine Risikoevaluation.

Umsetzung

Fast-Track-Behandlungsprotokolle beinhalten interdisziplinäre Patientenseminare, die die Erkrankung, Operation, schnellstmögliche Mobilisation und jeden einzelnen Teil der Behandlung erklären, wie auch einen „Coach“, einen Angehörigen oder Freund, der den Patienten auf dem Weg der Rehabilitation begleitet, unterstützt und ermutigt. Dadurch können Ängste reduziert werden. Digitale Apps können weitere Informationen und praktische Tipps vermitteln, durch Videos komplexe Abläufe veranschaulichen und dadurch das funktionelle Ergebnis verbessern und die Schmerzintensität reduzieren.

Risikofaktoren

Risikofaktoren, die zu einer höheren Morbidität, Mortalität und Komplikationsrate sowie einer längeren Aufenthaltsdauer führen, müssen evaluiert und, wenn möglich, eliminiert werden. Als optimierbare Faktoren gelten Malnutrition und Übergewicht, Alkoholkonsum, Nikotinabusus, der schlecht eingestellte Diabetes, der schlechte Zahnstatus und die Eisenmangelanämie.

Abstract

Background

Preoperative management of patients following fast-track arthroplasty protocols includes comprehensive patient information and risk stratification.

Implementation

Fast-track protocols have implemented interdisciplinary patient seminars to explain the disease, operation, pain management, early mobilisation and each step of the patient pathway, as well as the role of a friend or relative as a “coach” during the whole process of treatment and rehabilitation to support and encourage the patient. There is strong evidence that preoperative anxiety is reduced. Digital apps can provide further information, practical tips and instructional videos to improve functional outcomes and to reduce pain levels.

Risk factors

Risk factors such as malnutrition, obesity, smoking, alcohol abuse, uncontrolled diabetes, and poor dental health are associated with a higher morbidity, mortality, complication rate and a longer length of stay and have to be assessed preoperatively and optimized if possible.

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Abb. 1

Abbreviations

BMI:

Body-Mass-Index

ERAS :

„Enhanced recovery after surgery“

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Author information

Authors and Affiliations

  1. Vulpius Klinik GmbH, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland

    M. Clarius, J. Clarius & L. M. Clarius

  2. Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin, Deutschland

    L. Rackwitz & U. Nöth

Authors
  1. M. Clarius
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  2. L. Rackwitz
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  3. U. Nöth
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  4. J. Clarius
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  5. L. M. Clarius
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Corresponding author

Correspondence to M. Clarius.

Ethics declarations

Interessenkonflikt

M. Clarius ist Mitglied des European Advisory Boards „Rapid Recovery“ von Zimmer Biomet und hat für entsprechende Vortragstätigkeiten Honorare und Fahrtkostenerstattungen erhalten und bekommt Forschungsunterstützung von Zimmer Biomet und von B. Braun/Aesculap. L. Rackwitz, U. Nöth, J. Clarius und L.M. Clarius geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Clarius, M., Rackwitz, L., Nöth, U. et al. Prästationäres Management in der Fast-Track-Endoprothetik. Orthopäde 51, 352–357 (2022). https://doi.org/10.1007/s00132-022-04246-5

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  • DOI: https://doi.org/10.1007/s00132-022-04246-5

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