Enhanced recovery after surgery (ERAS) protocol reduces need for patient selection for day surgery total knee arthroplasty

Abstract

IntroductionThis study explored the safety and efficacy of Enhanced Recovery After Surgery (ERAS) together with a Day-surgery protocol on some commonly used selection criteria for expedited discharge after Total Knee Arthroplasty (TKA). MethodsERAS Day surgery TKA performed between Aug 2020 to July 2021 were included in this study. Discharge within 24 h was considered passing protocol. Complications such as infection, re-admission, and re-operation within 30-days were recorded. Patient demographics, medical comorbidities, and outcome measures at 6-month post-operatively were analysed between those who were successfully discharged within 24 h and those with prolong admission. ResultsA total of 342 patients were included in the study. 315 patients (92.1 %) were discharged within 24 h s. Inadequately controlled pain was the most common reason for delayed discharge (17.9 %). No statistically significant difference in gender, age, Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and American Society of Anaesthesiologist Classification (ASA) were noted between patients who failed protocol and those who passed. Readmission rate within 30days was 2.6 %. Infection occurred in 5 cases, including 2 prosthetic joint infection (PJI) requiring debridement, antibiotics, and implant retention (DAIR), 2 surgical site infection treated with antibiotics, and 1 pneumonia. No 30-days complication occurred in patients who initially failed ERAS Day-surgery protocol. Binary logistic regression was statistically insignificant on effect of gender, age, CCI, BMI, and ASA on passing protocol or 30-days complications. Propensity score matching of patients with prolong stay of more than 24 h did not demonstrate any difference in 6-month outcome. ConclusionPatient characteristics such as gender, age, CCI, BMI, and ASA did not influence successful completion of ERAS Day-surgery protocol. Even if patients were initially enrolled in ERAS Day-surgery protocol but failed to be discharged within 24 h, this did not predispose them to increased 30-days complication or poorer 6-month outcome. Level of evidenceIII.