Yoeri Bemelmans

Summary, Nederlandse samenvatting 177 12 Summary On a global scale, hip and knee arthroplasty surgeries as treatment for end-stage osteoarthritis are increasingly performed, making these operations one of the most performed and successful orthopaedic surgeries. Improvement of outcomes after these surgeries is not solely based on the surgical procedure itself. In the past decades, the introduction of so-called clinical pathways improved postoperative outcomes in terms of safety and efficacy. Making it nowadays possible to discharge patients faster (within 2 days), and in selected populations even on the day of surgery. A clinical pathway consists of a combination of pre-, peri- and postoperative protocols, which form the patients’ process (or journey) throughout their surgical procedure. Ideally, these protocols are the result of amulti-disciplinary approach (e.g. orthopaedic surgeon, physiotherapists, anaesthesiologists, hospital pharmacist, nurses, hospital managers, scrub nurses, operation room planners, physician assistants) and is completely based on the latest scientific evidence. This thesis examined several crucial components of these enhanced recovery pathways in the first place and adds new insights in outpatient joint arthroplasty pathways. Part one start with addressing and examination of several keystones in the formation of an enhanced recovery pathway for hip and knee arthroplasty. As preoperative information influences postoperativeoutcomes (in terms of satisfaction, by addressing expectations), type and form of provided information is paramount. In chapter 2 the patients’ experiences on the usage of an information brochure handed out to knee arthroplasty patients were investigated. Within this brief qualitative study, patients reported to be satisfiedwith the provided information brochure, making this an adequate method to prepare patients for surgery. Although patients reported no need for digital forms of information (e.g. websites, applications), the debate on these types of information sources will continue in future due to the digitization within society. After hip and knee arthroplasty, the need for postoperative blood transfusions rise up to 20%. The potential side effects of blood transfusions and the increased risks of complications after these transfusions (e.g. postoperative joint infection) make it undesirable. The introduction of tranexamic acid (TXA) reduced these numbers significantly. In chapter 3 the current TXA protocol (combining oral and intravenous administration) was retrospectively examined by investigating the transfusion rates in a large cohort of 5205 hip and knee arthroplasty patients. Only 0.9% of the patients received perioperative allogenic blood transfusions. Several clinical factors (e.g. age, body-mass index, American Society of Anaesthesiologists score, duration of surgery,