Enhanced recovery after surgery for hip and knee arthroplasty
Our experiences at the department of orthopedic surgery in GH Jesenice
Abstract
As the general population is ageing there is a growing number of total joint arthroplasty procedures in patients with degenerative joint diseases. On the other hand, the financial resources for healthcare budget are limited or even decreasing. The enhanced recovery after surgery (ERAS) protocol can decrease patients` in-hospital lenght of stay (LOS) without compromising the quality of treatment, thus being beneficial both for the patients as well as for hospital budget.
ERAS protocol for patients undergoing primary total knee or hip arthroplasty was partially implemented at the General hospital Jesenice in 2014. It was then optimised and upgraded with preoperative education for patients and their relatives, with all patients being treated according to the complete ERAS protocol in 2015.
The analysed outcome measures were in-hospital LOS and readmissions in the first 30 days after discharge. Before the ERAS implementation, the median LOS in 2013 and 2014 was 6.45 and 6.4 days respectively. It was significantly reduced after ERAS implementation, with the median LOS 4.4 days in years 2015 and 2016 and 3.5 days in 2017. Readmission rate in the first 30 days after discharge showed no significant differences before and after the implementation of ERAS protocol.
The ERAS protocol has been successfully and effectively implemented at our department, with LOS being significantely reduced without an increase in the rate of postoperative complications. This was achieved with several multidisciplinary changes before (preoperative educations) and during hospitalisation, with peri- and postoperative optimisation of blood management (regular use of tranexamic acid), pain control (multimodal opioid sparing analgesia) and especially with optimisation in physiotherapy.
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