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Following ERAS Protocol Associated With Better Outcomes After Hip, Knee Surgery

Following ERAS Protocol Associated With Better Outcomes After Hip, Knee Surgery

NEW YORK (Reuters Health) – Greater adherence to the Enhanced Recovery After Surgery (ERAS) care protocol is associated with fewer complications after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA), according to a prospective multicenter cohort study.

In a paper in JAMA Surgery, Dr. Javier Ripolles-Melchor of Infanta Leonor University Hospital, in Madrid, and colleagues note that postoperative complications after these procedures increase hospital length of stay (LOS).

The multidisciplinary perioperative measures in ERAS, such as good analgesic control and early mobilization, aim to reduce complications but, say the authors, “adoption is slow and adherence to ERAS guidelines is low.”

To characterize current management strategies, the researchers studied more than 6,100 patients undergoing THA and TKA at 131 centers in Spain. Overall, a quarter were operated on in self-designated ERAS centers.

During follow-up of 30 days after surgery, 11.1% of patients experienced postoperative complications, but there was no significant difference between the ERAS and non-ERAS groups (10.2% vs. 11.4%). However significantly fewer patients in the ERAS group had moderate to severe complications (4.6% vs. 6.1%).

ERAS adherence (calculated for each patient via 16 ERAS items) was 68.8% in the ERAS facilities and 50% in non-ERAS facilities. The researchers concede that they chose the individual ERAS items based on expert recommendations. “If we had selected other items,” they say, “the results might be different.”

Nevertheless, comparison of patients with the highest and lowest quartiles of adherence to ERAS components showed that those with the highest had significantly fewer overall postoperative complications (10.6% vs. 13.0%). This was also the case for severe postoperative complications (4.4% vs. 6.9%). Median length of hospital stay was also shorter (four vs. five days).

Only a few ERAS items were individually associated with improved outcomes. Based on these and other findings, the researchers conclude, “An effective pathway for THA and TKA consists of regional or local analgesia, anemia and bleeding management, and early mobilization as the basis of the care trajectory.”

Dr. Ripolles-Melchor did not respond to requests for comments.

SOURCE: JAMA Surgery, online February 12, 2020.

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