The Integration of Enhanced Recovery After Surgery (ERAS) Protocols in Orthopedic Surgery: Improving Outcomes and Reducing Hospital Stays
1Ali Raza, 2Mobeen ALI, 3Dr Muhammad Azeem Akhund, 4Dr Kishore Kumar khatri, 5Mohib Ali, 6Umar Raza
1PIMS
2PIMS
3Associate professor department of orthopedic surgery and traumatology PUMHS W Nawabshah
4Assistant professor Department of orthopedic surgery and traumatology PUMHS Nawabshah
5PIMS
6PIMS
Vol: 14/02
Received: January 25, 2024 Accepted: March 02, 2024 Published: May 20, 2024
Abstract
Background: ERAS pathways are the patient- and surgery-specific care strategies based on the published guidelines between the different professionals and aimed at decreasing surgical stress and improving postoperative outcome. It is argued that these protocols which were initially used in colorectal surgery can also be applied in orthopaedic surgery to solve challenges experienced such as pain, infection, long hospital stay and slow recovery.
Aim: This paper aims at assessing the effectiveness of implementation of ERAS protocols in orthopaedic surgery, particularly in relation to peri-operative morbidity and mortality, patients’ recovery duration, and measures of system productivity.
Method: The latter included retrospective and prospective of the study, and a definitive systematic review of scientific literature. A total of 800 patients who had elective orthopaedic surgeries given from total knee arthroplasty, total hip replacement, spine surgery to other operations. Preoperative ERAS interventions include patient education, optimization of nutritional status, smoking cessation, intraoperative which involves minimal invasive techniques,anesthesia multimodal, temperature control and finally; postoperative which consists of early mobilization, opioid sparing analgesia, patient discharge planning. While evaluating outcomes the time that patient spends in the hospital, rate of complications, rate of readmission post-surgery, pain threshold, and functionality was observed along with cost-benefit analysis.
Results: The use of ERAS protocols led to reduced hospital length of stay by 44.8%, less surgical site infections (2.1%vs.5.5%) and venous thromboembolism (0.8% vs. 2.8%), and reduced opioid consumption by 60%. mobilization and patient satisfaction significantly enhanced in ERAS group as compared with non-ERAS group regarding the functional recovery where 80 percent of the patient in ERAS group was ambulatory after 48 hours while 45 percent of patients in non-ERAS group. However, in subgroup analysis the results indicated improvisation in elderly patient. All primary as well as secondary findings were found be statistically significant with the p value being less than 0.05.
Conclusion: By creating ERAS protocols there is an improvement of patient’s result in orthopaedic surgery through decreased length of hospital stay, complications and dependency on opioids but increased recovery and satisfaction. These studies provide evidence for the widespread implementation of ERAS as practice normalization and increase the efficiency of the treatment. The next directions for research should be aimed at the fine-tuning of detailed protocols of certain sub-specialisms, the issues with the implementation process, and the opportunities of applying telemonitoring and patient self-management in this setting.
Keywords: Enhanced Recovery After Surgery, ERAS, orthopedic surgery, patient outcomes, hospital length of stay, multimodal pain management, functional recovery, healthcare efficiency.