Yoeri Bemelmans

General discussion and valorization 165 11 General discussion Arthroplasty surgeries are globally increasingly performed due to ageing of the population and higher demands of functional capabilities in (working) life [1,2]. Cost- effectiveness andmaximum functional recovery after surgery is therefore of increasing importance. To satisfy this higher volume and high-demanding expectations, the outcomes after surgery should ideally be evaluated and adjusted according to most recent literature. The improvement of healthcare is an ongoing process, rather than an one-way optimisation process, which should be initiated by the complete multi- disciplinary team (e.g. orthopaedic surgeon, physiotherapists, anaesthesiologists, hospital pharmacist, nurses, hospital managers, scrub nurses, operation room planners, physician assistants) involved in the orthopaedic care regarding hip and knee arthroplasty. It holds an indispensable role to optimise outcomes after surgery, with a possible reduction of costs of the complete pre-, peri- and postoperative procedure [3]. A combination of an optimised arthroplasty pathway to reduce side-effects and/or (S) AEs, and shortened LOS, will eventually contribute to a sustainable social-economic solution for this increasing demand [4]. The conductionof a perioperative arthroplasty pathway is done by further elaborationof the steps included in this pathway. As presented in part 1, several protocol optimisations led to improvement of patient preoperative information, more adequate perioperative blood management to prevent for blood transfusions, low postoperative amount of urinary retentions with omission of urinary catheters and acceptable pain scores to mobilize patients early after surgery. This step-wise work process is needed to cope with potential setbacks. It is not only the protocol itself which makes an optimisation effective and successful. The ongoing process towards the ‘perfect’ protocol is of even more importance. To incorporate the protocol in the current work processes, the involvement of all stakeholders is crucial. As, for example, orthopaedic surgeons and anaesthesiologists, need to stepover traditionswithin the care of arthroplasty patients to reducemorbidity, mortality and costs [5]. In this matter, cost reduction is not only based on LOS, but it is also found by the introduction and optimisation of clinical protocols. For example, by implementing TXA, a tremendous decrease in postoperative blood transfusions was found. These transfusions are not only expensive but can potentially increase (S)AEs (e.g. thromboembolic events, infections), which also contribute tohigher costs [6,7]. The same results are found after implementation of LIA in knee arthroplasty surgery. It decreased postoperative pain scores and makes it possible for patients to mobilize early after surgery, which improves outcomes and decreases LOS [8-11].