Early Results of ERAS (Enhanced Recovery After Surgery) Protocol in Orthopaedic Surgery (original) (raw)
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JAMA Surgery
IMPORTANCE The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. OBJECTIVE To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. EXPOSURES Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. MAIN OUTCOMES AND MEASURES The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. RESULTS During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). CONCLUSIONS AND RELEVANCE An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.
Turkish Journal of Anesthesia and Reanimation
Objective: The number of indications for total hip replacement (THR) and total knee replacement (TKR) surgery is increasing. Enhanced recovery after surgery (ERAS) represents the next step in the evolution of standardised care. The primary aim of this study is to measure the in-hospital 30-day medical and surgical postoperative complications rate. The study's secondary aims are to determine the length of stay, 30-day mortality rate, 30-day reoperation and readmission rates, the ERAS overall compliance and predefined ERAS individual items compliance. Methods: This multicentre, prospective, observational study will include adult patients (aged >18 years) undergoing elective THR and TKR surgery. Consecutive patients undergoing surgery within the 2-month data collection period will be included. Centres that offer the THR and/or TKR surgery will be eligible to participate. The data collection will be done through an online data collection form via a secure, password-protected platform at each centre with predefined data fields.
Enhanced recovery after surgery (ERAS): an orthopaedic perspective
Journal of perioperative practice, 2013
Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery.
Acta Orthopaedica, 2019
OL-Co-founder of and Chairman of the Executive Committee of the ERAS Society. Founder and shareholder in Encare AB, Advisor to Nutricia, NL; Advanced Medical Nutrition, Can. Speaker's honoraria and travel support from Nutricia, Fresenius-kabi, BBraun, Merck, Medtronic, and Baxter. TW conceived and designed the study. TW, MG, OL, DM, RGM, MR, OS, and PY all contributed to data collection and manuscript writing. All authors provided critical input on the manuscript. Acta thanks Henrik Husted and Stephan Vehmeijer for help with peer review of this study.
Orthopaedics & Traumatology: Surgery & Research, 2019
Introduction.-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. Hypothesis.-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. Material and methods.-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. Results.-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. Discussion.-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 of evidence.-Level II.
International Journal of Orthopaedic and Trauma Nursing, 2011
Background: A short stay elective centre was opened in 2007 at The Alfred in Melbourne, Australia. The objective was to safely discharge patients home on the third post-operative day. This prospective observational study reports the outcomes for hip and knee replacement patients during the first year of operation. Methods: Forty-seven patients (28 women and 19 men; mean age 65 years) were eligible for the study. Data was collected at preadmission, discharge and 6 months. Results: Thirty-four of 47 patients (72.3%) achieved discharge home within 3 days. Mean length of stay for the whole group was 4.55 days (95% CI 3.78–5.33 days). Patients who had medical complications were significantly more likely to stay longer than 3 days (p < 0.001). Patients with more pre-operative co-morbidity were more likely to suffer a post-operative medical complication resulting in a stay longer than 3 days (p = 0.09). Six month re-admission rates were 6% for those with a 3 day discharge and 15% for others. Conclusions: Preliminary findings suggest that a 3-day length of stay is possible for a defined group of patients, and can be achieved without increase in complication or re-admission rates. Failure to achieve Day 3 discharge is primarily related to medical complications.
2021
BACKGROUND: The benefits of combining enhanced recovery after surgery (ERAS) interventions with an outpatient program for total hip/knee arthroplasty (THA/TKA) are uncertain. The primary objective was to compare adverse event rate and secondly to compare pain management, functional recovery, PROMs and satisfaction in patients who experienced both an ERAS-outpatient protocol and standard-inpatient care.METHODS: We conducted an ambidirectional single subject cohort study on 48 consecutive patients who experienced both a standard-inpatient and an ERAS-outpatient THA/TKA (contralaterally). We compared complications according to Clavien-Dindo scale and Comprehensive Complications Index (CCI), and unplanned episodes of care. Postoperative pain assessed with a numeric rating scale, opioid consumption in morphine milligram equivalents, functional recovery, patient-reported outcome measures (WOMAC, KOOS, HOOS, Forgotten Joint Score and Patient Joint Perception) and patients’ satisfaction wer...
Journal of clinical nursing, 2016
To describe and compare the quality of recovery on discharge from hospital among patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today's shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with quality of recovery at discharge from hospital. A descriptive, comparative study including 12 hospitals in 5 European countries; Cyprus, Finland, Greece, Iceland and Sweden. Consecutively included patients responded on: health-related quality of life, and emotions before surgery and at hospital discharge; quality of recovery, patient satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. I...
Medicina, 2021
The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ...