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This retrospective cohort study evaluated the impact of an Enhanced Recovery After Surgery (ERAS) protocol incorporating the Safe Brain Initiative (SBI) on TKA outcomes. 204 patients undergoing elective TKA (138 ERAS-SBI, 66 pre-ERAS-SBI) were compared, demonstrating that the ERAS-SBI group experienced significantly shorter hospital stays, reduced time to discharge, and lower postoperative opioid consumption. The ERAS-SBI group also had reduced perioperative anaemia and blood transfusion rates.
Implementing an ERAS protocol with SBI reduces hospital stay and opioid consumption following TKA.
Objective Enhanced recovery after surgery (ERAS) protocols are recognised for improving postoperative outcomes. Integrating structured prehabilitation with the safe brain initiative (SBI) may further enhance these benefits. This study evaluated the impact of an ERAS-SBI programme on postoperative recovery and analgesic requirements in patients undergoing total knee arthroplasty (TKA). Methods This retrospective single-centre cohort study included adults classified as American Society of Anesthesiologists I-III who underwent elective TKA at a tertiary-care teaching hospital. Outcomes of patients managed with the ERAS-SBI programme (n = 138; December 2023-2024) were compared with those of patients treated prior to programme implementation (n = 66; December 2022-2023). The primary outcome was the length of hospital stay. Secondary outcomes included timing of postoperative discharge and cumulative rescue opioid analgesia at 24 and 48 hours. Results The ERAS-SBI group had a significantly shorter hospital stay than the pre-ERAS-SBI group (P < 0.001). The time to postoperative discharge was also reduced (P < 0.001). Rescue opioid analgesia consumption at 24 and 48 hours was significantly lower in the ERAS-SBI group (P < 0.001 for both comparisons). Perioperative anaemia and blood transfusion rates were reduced in the ERAS-SBI group (P=0.007 and P=0.003, respectively). Conclusion Implementing an ERAS-SBI pathway, incorporating a dedicated prehabilitation-focused ERAS outpatient clinic, is associated with shorter hospitalisation and reduced postoperative analgesic requirements following TKA. These findings support the role of enhanced multidisciplinary perioperative optimisation in improving clinical outcomes.
