ENHANCED ORTHOPAEDIC RECOVERY

Abstract

Enhanced Orthopaedic Recovery (EOR) is an evidence-based, integrated, multi-modal approach to improving recovery following elective orthopaedic surgery. The principles of EOR are to reduce time to functional recovery of postoperative patients safely with subsequent benefits to their length of stay in hospitals, their quality of life and health economics and outcomes. The combination of interventions used has been shown to be effective following major gastro-intestinal surgery but have not been tested in Orthopaedics until now. They aim to reduce the stress response provoked by surgery and the peri-operative catabolic state by optimally managing patient metabolism, post-operative pain, mobility and expectations.

Simple interventions along the patients’ journey include pre-operative educational classes, pre-operative carbohydrate loading, a (short) two hour fast ensuring surgery performed on anabolic patients, post operative pain and metabolic optimisation, empowering patients with ownership of their post-operative recovery and proactive post-discharge management. We found that these simple interventions translate well into elective orthopaedic arthroplasty surgery, can be achieved without additional cost and have little impact on intra-operative practice.

We conducted a single surgeon, consecutive patient, interventional, cohort study of lower limb primary joint arthroplasty surgery (primary total knee and primary total hip arthroplasty) in a busy district general hospital, 30 bed orthopaedic department. We reviewed the preceding 141 primary joint replacements (75 total hip and 66 total knee arthroplasties) before prospectively assessing the next 50 total hip and 32 total knee arthroplasties. A Mann-Whitney test between the two periods showed a highly statistically significant fall in time to discharge (median hospital stay 6.5 - 4 nights, p< 0.001). We noted no adverse effects as a result implementing EOR.

We have shown that by implementing EOR, reduced time to functional recovery and subsequent hospital discharge can be safely achieved with consequent quality of life and health economic benefits.