February 13, 2020

Association between ERAS and postop complications after total hips and knees

By: Judy Mathias

Editor's Note

Increased adherence to an Enhanced Recovery After Surgery (ERAS) protocol after total hip arthroplasty (THA) and total knee arthroplasty (TKA) was associated with a decrease in postoperative complications in this study from Spain. However, only a few interventions were linked to decreased complications

In this analysis of 6,146 patients in 131 hospitals, no differences were found in the number of patients with overall postoperative complications between the ERAS (10.2%) and non-ERAS (11.4%) groups or in terms of readmission, reintervention, or survival.

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Comparing highest and lowest quartiles of adherence, patients who had the highest adherence to ERAS components had fewer overall postoperative complications (10.6% vs 13%), fewer moderate to severe postoperative complications (4.4% vs 6.9%), and shorter length of stay (4 vs 5 days), regardless of whether the hospital had an established ERAS protocol.

The median overall adherence rate with the ERAS protocol was 50%, with ERAS facilities at a rate of 68.8% and non-ERAS facilities at 50%.

Because only a few perioperative interventions were associated with decreased complications—ie, local analgesia, anemia and bleeding management,  and early mobilization—the findings suggest that the focus should be on these elements of care rather than expanding adherence to the other components in most ERAS protocols, the researchers say.


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