Abstract
Introduction
Enhanced Recovery Protocol (ERP) for elective total hip or total knee replacement has become the gold standard. The main principles are to reduce bleeding, both with a tranexamic acid infusion and local injection of adrenaline, and to reduce the risk of postoperative thrombo-embolic complications by early mobilisation, enabled by local anaesthetic infiltration at time of surgery. The aim of this study is to evaluate the impact of the ERP.
Methods
A retrospective review was performed including all patients who underwent primary hip or knee arthroplasty surgery between January 2011 and December 2013. The ERP was implemented in our department in August 2012 thus creating two cohorts; the traditional postoperative group and those undergoing ERP. Outcome measurements of length of stay, postoperative transfusion, thrombo-embolic complications and number of re-admissions were assessed.
Results
1262 patients were included. The traditional group contained a total of 632 patients and the ERP group contained 630 patients. The number of patients receiving a blood transfusion postoperatively significantly decreased from 50 (7.9%) to 27 (4.3%) (p value <0.05). There was no statistical difference in postoperative thrombo-embolic events. The length of stay was reduced from 5.5 days to 4.8 days (P value <0.05). There was no difference in the number of re-admissions.
Conclusion
ERP has led to a significant decrease in transfusions after elective arthroplasty surgery, without increasing the incidence of thrombo-embolic events. Furthermore it has significantly reduced the length of stay which has obvious cost implications. This study agrees with the current literature in that enhanced recovery should indeed be the gold standard for elective arthroplasty procedures.
