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This study investigated the safety and efficacy of a non-selective enhanced recovery after surgery (ERAS) pathway for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a large cohort of patients (ERAS n=1811, Standard Care n=3549) using propensity score matching. The ERAS pathway significantly reduced length of stay (LOS) from 3 days to 1 day, with a more pronounced reduction in patients ≥80 years, while maintaining similar rates of readmission, infection, and mortality compared to standard care. The estimated cost reduction per patient with the ERAS pathway was £718.60.
Implementing a non-selective ERAS pathway for primary THA and TKA significantly reduces length of stay without increasing readmission, infection, or mortality rates.
Enhanced Recovery After Surgery (ERAS) was introduced in hip and knee arthroplasty to expedite recovery, shorten inpatient stay, and reduce costs. This study aims to investigate the safety and efficacy of implementing a universal standardized non-selective ERAS service for all patients admitted for primary hip and knee arthroplasty in a single high-volume tertiary orthopaedic centre. All patients who underwent primary hip or knee arthroplasty under ERAS from April 2023 to March 2024 were compared with a matched cohort between January 2018 and December 2019. Patients were matched at a 2:1 ratio based on procedure, age, sex, ASA grade, and BMI (ERAS = 1811, Standard Care = 3549 patients). Outcomes included Length of Stay (LOS), 30-day readmission, overall infection, superficial infection, deep infection, 30- and 90-day mortality rates. The median LOS was 1 day (IQR 1–2) in the ERAS group versus 3 days (IQR 2–4) in the Standard Care group (W = 5,415,769, P < 0.001). Rates of 30-day readmission (1.7% vs. 2.1%), overall infection (0.66% vs. 1.15%), deep infection (0.39% vs. 0.68%), superficial infection (0.28% vs. 0.48%), 30-day mortality (0.11% vs. 0.20%), and 90-day mortality (0.22% vs. 0.37%) were all higher in the Standard Care group. However, these differences were not statistically significant, with P-values of 0.41, 0.11, 0.26, 0.38, 0.70, and 0.52, respectively. The estimated cost reduction per patient with the ERAS pathway, considering only the difference in LOS, is £718.60(95%CI £602.56 to £832.64). The subgroup analysis for patients ≥ 80 revealed a statistically significant difference in LOS, which was more pronounced with a median difference of 3 days (5 days in standard care versus 2 days in ERAS, P < 0.001). Non-selective ERAS was safe and effective in reducing LOS for patients undergoing primary THA and TKA across all age groups and varying comorbidity statuses. Although perioperative morbidity and mortality were less in ERAS, these changes did not reach statistical significance.
