La cirugía de recuperación rápida en las artroplastias de rodilla y cadera. Una actualización

Abstract

Fast-track surgery, or enhanced recovery, has appeared in the last 20 years or so as a combination of the optimisation of clinical protocols and organisational processes, pursuing the reduction in surgical stress with the aim of reducing peri-operative comorbidities, convalescence time, and functional recovery, resulting in a reduction in admission time.After a review of the European literature available on this subject, this article attempts to present an update. It highlights its interest and origins, basically being set out as a response to the question: ‘Why is this patient in Hospital today?’ It also attempts to summarise the essence of such programmes: the search for immediate post-surgical mobilisation, being supported in a multidisciplinary approach. This includes a multimodal intervention and analgesia, a limitation in the use of opiates, and the active participation by the patients in their own recovery.Furthermore, mention is made of the initiatives by European State organisation as a boost to enhanced recovery programmes in their respective countries, as is the case in Denmark, France, and the United Kingdom.The clinical outcomes published up to September 2015 have been reviewed. A subsequent decrease in mean hospital stay is observed in 11 studies, achieving patient satisfaction, low complication rates, a reduction in the transfusion rates, and with no apparent increase in re-admissions.Mention is also made of the financial consequences, and how to implement these protocols.As a conclusion, an analysis is made of the future challenges fast-track surgery, such as the possibility of moving towards outpatient surgery, or the obtaining of a surgery ‘with no risk or pain’ in general, for which there are other still open lines of work.