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Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery

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Abstract

Purpose

Enhanced recovery after surgery (ERAS) protocols aim to develop peri-operative multidisciplinary programs to shorten length of hospital stay (LOS) and reduce complications, readmissions and costs for patients undergoing major surgery. The aim of this study is to evaluate the effects of an ERAS pathway for total hip (THR) and knee (TKR) replacement surgery in terms of length of stay, incidence of complications and patient satisfaction.

Methods

Patients scheduled for hip and knee replacement were included in the study. The main aspects of this program were preoperative education/physical therapy, rational choice of the anesthetic technique, optimization of multimodal analgesia, reduction of incidence of urinary retention and catheterization, active management of risk for blood loss and deep vein thrombosis, and early mobilization of the patients. All patients had 6 months predicted and planned follow-up appointments. Primary outcomes of the study were the mean LOS, readmission and complication rates. Secondary Outcomes were percentage of Knee Injury & Osteoarthritis Outcome Score (KOOS) and Hip disability and Osteoarthritis Outcome Score (HOOS) increase and patient’s satisfaction.

Results

We consecutively enrolled 207 patients who underwent total joint arthroplasty, 78 hip and 129 knee joint replacements. The mean length of stay (LOS) for patients of the two groups was 4.3 days for ASA 3-4 patients subjected to TKR and THR, in ASA 1-2 patients 3.6 days for TKR and 3.9 days for THR respectively. Postoperative satisfaction level was higher than 7 (very satisfied) in 94.4% of the cases. All patients were discharged home: 61.8% continued physical therapy in complete autonomy, 23.7% supported by a home-physiotherapist and only 14.5% needed the attendance to a physiotherapy center on a daily basis. The overall incidence of major complications was 3.4%.

Conclusions

The implementation of an ERAS program for hip and knee replacement surgery allows early patient’s discharge and a quick return to independency in the daily activities.

Level of evidence

IV.

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Authors and Affiliations

  1. Area Anestesiologia, Rianimazione, Terapie Intensive e Terapia del Dolore, Fondazione Policlinico A. Gemelli, Rome, Italy

    L. Frassanito, A. Vergari, R. Nestorini & M. Rossi

  2. Area Invecchiamento, Ortopedia e Riabilitazione, Fondazione Policlinico A. Gemelli, Rome, Italy

    G. Cerulli

  3. U. O. Ortopedia e Traumatologia, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy

    G. Placella

  4. Royal National Orthopedic Hospital, Stanmore, London, UK

    V. Pace

  5. Istituto di Anestesia e Rianimazione, Fondazione Policlinico A. Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy

    L. Frassanito

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  1. L. Frassanito
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  2. A. Vergari
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  3. R. Nestorini
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  4. G. Cerulli
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  7. M. Rossi
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Correspondence to L. Frassanito.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Frassanito, L., Vergari, A., Nestorini, R. et al. Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery. Musculoskelet Surg 104, 87–92 (2020). https://doi.org/10.1007/s12306-019-00603-4

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