Enhanced Recovery After Surgery in elective hip and knee arthroplasty reduces length of hospital stay.

Standardized perioperative care within an Enhanced Recovery After Surgery (ERAS) programme aims to reduce postoperative morbidity and length of hospital stay (LOS). This study evaluated the effect of ERAS in patients undergoing elective, primary total hip and knee arthroplasty (THA and TKA) in a New Zealand public hospital. Data collected prospectively on patients who had undergone THA and TKA in an ERAS programme (ERAS: August-December 2013) were compared to a retrospective cohort of patients managed in a traditional perioperative care environment (control: June-August 2012). The Breakthrough Series Model for Improvement provided a framework to implement components of the ERAS protocol. The primary outcome was median LOS. Secondary outcomes included 30-day readmission rates, complications and cost. There were 206 patients who met the eligibility criteria (106 ERAS, 100 control). There were no significant differences in baseline characteristics. After the implementation of ERAS, median LOS was reduced by 1 day (5 control versus 4 ERAS; P < 0.001). Short-term complications were similar (P = 0.372) as were readmission rates (P = 0.258). Cost analysis identified ERAS patients to have reduced cost overall. ERAS in THA and TKA has been shown to be safe and effective in improving recovery through shorter hospital stay.

Stowers MD ，Manuopangai L ，Hill AG ，Gray JR ，Coleman B ，Munro JT ... -  《-》

Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs.

An attractive option to reduce hospital length of stay (LOS) after hip or knee joint replacement (THA, TKA) is to follow the Enhanced Recovery After Surgery principles (ERAS) to improve patient experience to a level where they will feel confident to leave for home earlier. The objective of this study was to evaluate the implementation of short-stay protocol following the ERAS principles. We hypothesized that our ERAS THA and TKA short-stay protocol would result in a lower complication rate, shorter hospital LOS and reduced direct health care costs compared to our standard procedure. We compared the complications rated according to Clavien-Dindo scale, hospital LOS and costs of the episode of care between a prospective cohort of 120 ERAS short-stay THA or TKA and a matched historical control group of 150 THA or TKA. Significantly lower rate of Grade 1 and 2 complications in the ERAS short-stay group compared with the standard group (mean 0.8 vs 3.0, p<0.001). No difference was found between the 2 groups for Grade 3, 4, or 5 complications. The mean hospital LOS for the ERAS short-stay group decreased by 2.8 days for the THAs (0.1 vs 2.9 days, p<0.001) and 3.9 days for the TKAs (1.0 vs 4.9 days, p<0.001). The mean estimated direct health care costs reduction with the ERAS short-stay protocol was 1489 CAD per THA and 4158 CAD per TKA. In many short-stay protocols, focus has shifted from ERAS goals of a reduction in complications and improved recuperation to use length of stay as the main factor of success. Implementation of an ERAS short-stay protocol for patients undergoing THA or TKA at our institution resulted not only in reduced hospital LOS, but also in improved patient care and reduced direct health care costs. Level II.

Vendittoli PA ，Pellei K ，Desmeules F ，Massé V ，Loubert C ，Lavigne M ，Fafard J ，Fortier LP ... -  《Orthopaedics & Traumatology-Surgery & Research》

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplast

Ripollés-Melchor J ，Abad-Motos A ，Díez-Remesal Y ，Aseguinolaza-Pagola M ，Padin-Barreiro L ，Sánchez-Martín R ，Logroño-Egea M ，Catalá-Bauset JC ，García-Orallo S ，Bisbe E ，Martín N ，Suárez-de-la-Rica A ，Cuéllar-Martínez AB ，Gil-Trujillo S ，Estupiñán-Jiménez JC ，Villanova-Baraza M ，Gil-Lapetra C ，Pérez-Sánchez P ，Rodríguez-García N ，Ramiro-Ruiz A ，Farré-Tebar C ，Martínez-García A ，Arauzo-Pérez P ，García-Pérez C ，Abad-Gurumeta A ，Miñambres-Villar MA ，Sánchez-Campos A ，Jiménez-López I ，Tena-Guerrero JM ，Marín-Peña O ，Sánchez-Merchante M ，Vicente-Gutiérrez U ，Cassinello-Ogea MC ，Ferrando-Ortolá C ，Berges-Gutiérrez H ，Fernanz-Antón J ，Gómez-Ríos MA ，Bordonaba-Bosque D ，Ramírez-Rodríguez JM ，García-Erce JA ，Aldecoa C ，Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM) ... -  《-》

Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis.

Systematic review with meta-analysis. To evaluate the effects of enhanced recovery after surgery (ERAS) on the postoperative recovery of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA). The PubMed, Embase, Cochrane and ISI Web of Science databases were searched to identify literature including randomised controlled trials (RCTs), cohort studies and case-control studies through 2 May 2018. The analysed outcomes were mortality rate, transfusion rate, range of motion (ROM), 30-day readmission rate, postoperative complication rate and in-hospital length of stay (LOS). A total of 25 studies involving 16 699 patients met the inclusion criteria and were included in the meta-analysis. Compared with conventional care, ERAS was associated with a significant decrease in mortality rate (relative risk (RR) 0.48, 95% CI 0.27 to 0.85), transfusion rate (RR 0.43, 95% CI 0.37 to 0.51), complication rate (RR 0.74, 95% CI 0.62 to 0.87) and LOS (mean difference (MD) -2.03, 95% CI -2.64 to -1.42) among all included trials. However, no significant difference was found in ROM (MD 7.53, 95% CI -2.16 to 17.23) and 30-day readmission rate (RR 0.86, 95% CI 0.56 to 1.30). There was no significant difference in complications of TKA (RR 0.84, 95% CI 0.34 to 2.06) and transfusion rate in RCTs (RR 0.66, 95% CI 0.15 to 2.88) between the ERAS group and the control group. This meta-analysis showed that ERAS significantly reduced the mortality rate, transfusion rate, incidence of complications and LOS of patients undergoing TKA or THA. However, ERAS did not show a significant impact on ROM and 30-day readmission rate. Complications after hip replacement are less than those of knee replacement, and the young patients recover better. Level 1.

Deng QF ，Gu HY ，Peng WY ，Zhang Q ，Huang ZD ，Zhang C ，Yu YX ... -  《-》

Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services.

Proudfoot S ，Bennett B ，Duff S ，Palmer J ... -  《-》