Abstract
Background. Enhanced recovery (ER) for elective total hip or total knee replacement has become common practice. The aim of this study is to evaluate the impact of ER on transfusion rates and incidence of venous thromboembolism (VTE). Methods. A comprehensive review was undertaken of all patients who underwent primary hip or knee arthroplasty surgery electively between January 2011 and December 2013 at our institution. ER was implemented in August 2012, thus creating two cohorts: the traditional protocol (TP) group and the ER group. Outcome measurements of length of stay, postoperative transfusion, thromboembolic complications, and number of readmissions were assessed. Main Findings. 1262 patients were included. The TP group contained a total of 632 patients and the ER group contained 630 patients. Postoperative transfusion rate in the ER group was reduced with 45% (P≤0.05). There was no statistical difference in postoperative VTE complications. The length of stay was reduced from 5.5 days to 4.8 days (P<0.05). Conclusions. There was no difference in the number of readmissions. ER has contributed to a significant decrease in transfusions after elective arthroplasty surgery, with no increase in the incidence of thromboembolic events. Furthermore, it has significantly reduced inpatient length of stay.
Highlights
Several studies advocating enhanced recovery (ER) or fasttrack protocol for elective total hip or total knee replacement have been published and it is becoming the common practice for arthroplasty surgery in most hospitals in the United Kingdom
There was a drop in the number of patients who underwent a blood transfusion between the TR group and the ER group for both procedures
This study demonstrates that, since the introduction of our local ER protocol, blood transfusion for patients undergoing elective total hip or total knee replacement has been significantly reduced, without increasing the number of venous thromboembolism (VTE) complications
Summary
Several studies advocating enhanced recovery (ER) or fasttrack protocol for elective total hip or total knee replacement have been published and it is becoming the common practice for arthroplasty surgery in most hospitals in the United Kingdom. ER protocols are commonly developed and tailored to given units routine practice, but common themes include preoperative patient education, perioperative administration of tranexamic acid and defined standards for anaesthesia and postoperative analgesia, fluid management, and early mobilisation. This multidisciplinary approach has been proven to be beneficial for the patient with a significant reduction of early postoperative complications and a reduction in length of stay (LOS) [1,2,3,4,5]. ER has contributed to a significant decrease in transfusions after elective arthroplasty surgery, with no increase in the incidence of thromboembolic events It has significantly reduced inpatient length of stay
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