Abstract
ObjectiveTo examine the current perspectives of enhanced recovery after surgery (ERAS) and the clinical practice applications of important ERAS principles among Chinese orthopaedic surgeons.MethodsThis was a cross‐sectional study using an online survey that was completed between November and December 2018. A 16‐item online questionnaire regarding the experiences of ERAS, perceptions of methods, and durations and concerns of venous thromboembolism (VTE) prophylaxis was sent to 2000 orthopaedic surgeons nationwide, and 1720 (86%) surgeons responded. Statistical analyses were conducted to assess all respondents' results and to compare differences among subgroups that were stratified according to city and hospital level, as well as their professional title.ResultsAccording to the results of the survey, ERAS awareness was high (65.1%) and most surgeons recognized the importance of thromboprophylaxis. However, the timing of ERAS was not consistent, with 22.8%, 31.9%, and 37.7% of surgeons choosing to initiate pharmaceutical prophylaxis within <6 h, 6–12 h, and 12–24 h after surgery, respectively. Low‐molecular‐weight heparin was mainly selected during hospitalization, and new oral anticoagulants (NOACs) were the first choice after discharge. Regarding postoperative antithrombotic therapy, particularly when combined with analgesics, the potential bleeding risk was mostly considered (80.0%)Tranexamic acid was believed to have no effect on the timing of NOAC therapy initiation (56.2%). Most of the above outcomes were influenced by the hospital level and professional title of the surgeon. Surgeons who had higher awareness on ERAS and better adhered to the guidelines were from higher‐level hospitals as well as had more advanced professional titles. City level partly might influence their practice but not impact surgeons' awareness.ConclusionsThe awareness and perception of the concept of ERAS and prophylactic antithrombotic regimens remain different among Chinese orthopaedic surgeons in different level cities and with various professional titles. Continuing medical educations (CME) on VTE prophylaxis is needed for improving the quality of health care in China.
Highlights
The concept of enhanced recovery after surgery (ERAS) was first proposed by Kehlet in the 1990s1
The present study aimed to investigate the understanding of ERAS and venous thromboembolism (VTE) prevention among orthopaedic surgeons from different backgrounds and related factors such as the method, duration, and consideration of pharmacologic prophylaxis
Choices of Pharmaceutical Therapy in Practice and Concerns Most surgeons agreed to consider the management of VTE prophylaxis after arthroplasty
Summary
The concept of enhanced recovery after surgery (ERAS) was first proposed by Kehlet in the 1990s1. The goals of ERAS are to promote faster recovery, reduce postoperative complications, shorten the length of stay (LOS), reduce economic burden, and improve patient satisfaction using evidence-based methods[2]. When it was first applied in gastrointestinal surgery, successful implementation of ERAS protocols and the adherence to ERAS protocols that achieved satisfactory outcomes. ERAS has been adopted in various fields such as general surgery, cardiothoracic surgery, orthopaedics, gynecology, and urology[3,4,5,6]
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