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- Title
Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis.
- Authors
Zhang, Qingqing; Chen, Yuzhang; Li, Yi; Liu, Ruikang; Rai, Saroj; Li, Jin; Hong, Pan
- Abstract
Purpose Enhanced recovery after surgery (ERAS) was characterized as patient-centered, evidence-based, multidisciplinary team-developed routes for a surgical speciality and institution to improve postoperative recovery and attenuate the surgical stress response. However, evidence of their effectiveness in osteoarthroplasty remains sparse. This study aimed to develop an ERAS standard and evaluate the significance of ERAS interventions for postoperative outcomes after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods We searched Medline, Embase, Cochrane databases, and Clinicaltrials.gov for randomized controlled trials, cohort studies, and case–control studies until 24 February 2023. All relevant data were collected from studies meeting the inclusion criteria. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was the length of stay (LOS), postoperative complications, and readmission rate. The secondary outcomes included transfusion rate, mortality rate, visual analog score (VAS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Short Form 36 (SF-36) bodily pain (SF-36 BP), SF-36 physical function (SF-36 PF), oxford knee score, and range of motion (ROM). Results A total of 47 studies involving 76 971 patients (ERAS group: 29 702, control group: 47 269) met the inclusion criteria and were included in the meta-analysis. The result showed that ERAS could significantly shorten the LOS (WMD = −2.65, P < .001), reduce transfusion rate (OR = 0.40, P < .001), and lower 30-day postoperative mortality (OR = 0.46, P = .01) without increasing postoperative complications or readmission rate. Apart from that, ERAS may decrease patients' VAS (WMD = −0.88, P = .01) while improving their ROM (WMD = 6.65, P = .004), SF-36 BP (WMD = 4.49, P < .001), and SF-36 PF (WMD = 3.64, P < .001) scores. However, there was no significant difference in WOMAC, oxford knee score between the ERAS and control groups. Furthermore, we determined that the following seven components of the ERAS program are highly advised: avoid bowel preparation, PONV prophylaxis, standardized anesthesia, use of local anesthetics for infiltration analgesia and nerve blocks, tranexamic acid, prevent hypothermia, and early mobilization. Conclusion Our meta-analysis suggested that the ERAS could significantly shorten the LOS, reduce transfusion rate, and lower 30-day postoperative mortality without increasing postoperative complications or readmission rate after THA and TKA. Meanwhile, ERAS could decrease the VAS of patients while improving their ROM, SF-36 BP, and SF-36 PF scores. Finally, we expect future studies to utilize the seven ERAS elements proposed in our meta-analysis to prevent increased readmission rate for patients with THA or TKA. Key message What is already known on this topic A growing number of studies have identified a positive role for ERAS in arthroplasty; however, the clinical effectiveness and elements of ERAS need to be further defined. What this study adds This research not only assesses the influence of ERAS on length of stay, complications, and readmission rates, but further evaluates the impact of ERAS on joint function and proposes the recommended seven elements of ERAS. How this study might affect research, practice, or policy Given the potential advantages of ERAS, we encourage its use in arthroplasty and anticipate that future research will incorporate our proposed seven ERAS elements to prevent higher readmission rates in THA or TKA patients. Registration number CRD42023390678.
- Subjects
MCMASTER University; ENHANCED recovery after surgery protocol; TOTAL hip replacement; EARLY ambulation (Rehabilitation); TOTAL knee replacement; NERVE block; SURGICAL complications; PHYSICAL mobility
- Publication
Postgraduate Medical Journal, 2024, Vol 100, Issue 1181, p159
- ISSN
0032-5473
- Publication type
Article
- DOI
10.1093/postmj/qgad125