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

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: ERAS in THA and TKA has been shown to be safe and effective in improving recovery through shorter hospital stay.