Early Results of ERAS (Enhanced Recovery After Surgery) Protocol in Orthopaedic Surgery

Abstract

Background: The concept of a fast track (Enhanced Recovery After Surgery, ERAS) was introduced to colorectal surgery in Denmark by Kehlet in 1999 which improved the quality of the care and reduced the length of hospital stay following major colorectal surgery. The same principles of ERAS have been applied to the orthopaedic surgery particularly the hip and knee replacement surgery and fracture neck of femur surgery. It is a relatively new approach in orthopaedics to the preoperative, intraoperative and postoperative care of the patients undergoing surgery.   Methods: We have compared the length of inpatient stay, day of mobilisation, postoperative blood transfusion and adverse outcome for the patients undergoing hip or knee replacement by a single surgeon (KS) between ERAS and NON ERAS patients.   Results: A total of 138 patients underwent hip or knee replacement, hip resurfacing arthroplasty or oxford unicompartmental arthroplasty between July 2011 and June 2012 with ERAS protocol. In the Non-ERAS group, 140 patients underwent hip or knee arthroplasty, resurfacing or oxford uni-compartmental knee replacement in the previous year (July 2010 to June 2011) by the same surgeon. Average hospital inpatient stays for the ERAS patients was 4.12 days with 73.10% of the patients having an inpatient hospital stay of less than or equal to 5 days. The average hospital inpatient stays for the NON-ERAS patients was 8.34 days with only 24.08% of the patients being discharged in less than or equal to 5 days.   Conclusions: Our study shows that the implementation of the ERAS protocol in hip and knee replacement surgery is associated with improved patient experience, faster recovery and shorter hospital inpatient stay with no increase in complication.