An enhanced recovery after surgery program for hip and knee arthroplasty

Nicholas Christelis, Sophia Wallace, Claire Sage, Uate Babitu, Susan M Liew, James Dugal, Ibolya Nyulasi, Nora Mutalima, Ton Tran, Paul S Myles

Research output: Contribution to journalArticleResearchpeer-review

Abstract

To institute and evaluate the benefits of an enhanced recovery after surgery (ERAS) program across three hospitals in Victoria. Design, setting and participants: We used a before-and-after quality improvement study design consisting of three phases: pre-ERAS program data collection from March to September 2012; ERAS training and implementation during September 2012; and change performance measurement following ERAS implementation from October 2012 to May 2013. Main outcome measures: The primary end point was duration of hospital stay after knee or hip arthroplasty. Secondary end points were adherence to the ERAS bundle, and process and patient recovery characteristics. Results: We enrolled 412 patients to the pre-ERAS (existing-practice) phase and compared them with 297 patients in the ERAS phase. For ERAS patients, compared with existing-practice patients, hospital stay was reduced (geometric mean, 5.3 [SD, 1.6] v 4.9 [SD, 1.6] days; P <0.001) and there was a significant improvement in the proportion of patients ready for discharge on Day 3 after surgery (41 v 59 ; P <0.001). The most common reason for delayed discharge was patients waiting for review or access to rehabilitation services. There were markedly improved indicators of processes and outcomes of care, including improved patient education, reduced fasting times, less blood loss, better analgesia, earlier ambulation and improved overall quality of recovery. Conclusion: We found that an ERAS program could be successfully implemented in elective joint arthroplasty, leading to a shorter duration of hospital stay. We recommend this orthopaedic ERAS pathway. ? 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)363 - 369
Number of pages7
JournalMedical Journal of Australia
Volume202
Issue number7
DOIs
Publication statusPublished - 2015

Cite this

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title = "An enhanced recovery after surgery program for hip and knee arthroplasty",
abstract = "To institute and evaluate the benefits of an enhanced recovery after surgery (ERAS) program across three hospitals in Victoria. Design, setting and participants: We used a before-and-after quality improvement study design consisting of three phases: pre-ERAS program data collection from March to September 2012; ERAS training and implementation during September 2012; and change performance measurement following ERAS implementation from October 2012 to May 2013. Main outcome measures: The primary end point was duration of hospital stay after knee or hip arthroplasty. Secondary end points were adherence to the ERAS bundle, and process and patient recovery characteristics. Results: We enrolled 412 patients to the pre-ERAS (existing-practice) phase and compared them with 297 patients in the ERAS phase. For ERAS patients, compared with existing-practice patients, hospital stay was reduced (geometric mean, 5.3 [SD, 1.6] v 4.9 [SD, 1.6] days; P <0.001) and there was a significant improvement in the proportion of patients ready for discharge on Day 3 after surgery (41 v 59 ; P <0.001). The most common reason for delayed discharge was patients waiting for review or access to rehabilitation services. There were markedly improved indicators of processes and outcomes of care, including improved patient education, reduced fasting times, less blood loss, better analgesia, earlier ambulation and improved overall quality of recovery. Conclusion: We found that an ERAS program could be successfully implemented in elective joint arthroplasty, leading to a shorter duration of hospital stay. We recommend this orthopaedic ERAS pathway. ? 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.",
author = "Nicholas Christelis and Sophia Wallace and Claire Sage and Uate Babitu and Liew, {Susan M} and James Dugal and Ibolya Nyulasi and Nora Mutalima and Ton Tran and Myles, {Paul S}",
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An enhanced recovery after surgery program for hip and knee arthroplasty. / Christelis, Nicholas; Wallace, Sophia; Sage, Claire; Babitu, Uate; Liew, Susan M; Dugal, James; Nyulasi, Ibolya; Mutalima, Nora; Tran, Ton; Myles, Paul S.

In: Medical Journal of Australia, Vol. 202, No. 7, 2015, p. 363 - 369.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - An enhanced recovery after surgery program for hip and knee arthroplasty

AU - Christelis, Nicholas

AU - Wallace, Sophia

AU - Sage, Claire

AU - Babitu, Uate

AU - Liew, Susan M

AU - Dugal, James

AU - Nyulasi, Ibolya

AU - Mutalima, Nora

AU - Tran, Ton

AU - Myles, Paul S

PY - 2015

Y1 - 2015

N2 - To institute and evaluate the benefits of an enhanced recovery after surgery (ERAS) program across three hospitals in Victoria. Design, setting and participants: We used a before-and-after quality improvement study design consisting of three phases: pre-ERAS program data collection from March to September 2012; ERAS training and implementation during September 2012; and change performance measurement following ERAS implementation from October 2012 to May 2013. Main outcome measures: The primary end point was duration of hospital stay after knee or hip arthroplasty. Secondary end points were adherence to the ERAS bundle, and process and patient recovery characteristics. Results: We enrolled 412 patients to the pre-ERAS (existing-practice) phase and compared them with 297 patients in the ERAS phase. For ERAS patients, compared with existing-practice patients, hospital stay was reduced (geometric mean, 5.3 [SD, 1.6] v 4.9 [SD, 1.6] days; P <0.001) and there was a significant improvement in the proportion of patients ready for discharge on Day 3 after surgery (41 v 59 ; P <0.001). The most common reason for delayed discharge was patients waiting for review or access to rehabilitation services. There were markedly improved indicators of processes and outcomes of care, including improved patient education, reduced fasting times, less blood loss, better analgesia, earlier ambulation and improved overall quality of recovery. Conclusion: We found that an ERAS program could be successfully implemented in elective joint arthroplasty, leading to a shorter duration of hospital stay. We recommend this orthopaedic ERAS pathway. ? 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.

AB - To institute and evaluate the benefits of an enhanced recovery after surgery (ERAS) program across three hospitals in Victoria. Design, setting and participants: We used a before-and-after quality improvement study design consisting of three phases: pre-ERAS program data collection from March to September 2012; ERAS training and implementation during September 2012; and change performance measurement following ERAS implementation from October 2012 to May 2013. Main outcome measures: The primary end point was duration of hospital stay after knee or hip arthroplasty. Secondary end points were adherence to the ERAS bundle, and process and patient recovery characteristics. Results: We enrolled 412 patients to the pre-ERAS (existing-practice) phase and compared them with 297 patients in the ERAS phase. For ERAS patients, compared with existing-practice patients, hospital stay was reduced (geometric mean, 5.3 [SD, 1.6] v 4.9 [SD, 1.6] days; P <0.001) and there was a significant improvement in the proportion of patients ready for discharge on Day 3 after surgery (41 v 59 ; P <0.001). The most common reason for delayed discharge was patients waiting for review or access to rehabilitation services. There were markedly improved indicators of processes and outcomes of care, including improved patient education, reduced fasting times, less blood loss, better analgesia, earlier ambulation and improved overall quality of recovery. Conclusion: We found that an ERAS program could be successfully implemented in elective joint arthroplasty, leading to a shorter duration of hospital stay. We recommend this orthopaedic ERAS pathway. ? 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.

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DO - 10.5694/mja14.00601

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EP - 369

JO - Medical Journal of Australia

JF - Medical Journal of Australia

SN - 0025-729X

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