Enhanced recovery programmes for lower limb arthroplasty in the UK

Area of Science:

• Orthopaedic surgery
• Patient recovery protocols

Background:

• Enhanced recovery programmes (ERPs) are proven to reduce patient morbidity, mortality, and hospital length of stay, leading to significant cost savings.
• No uniform ERP guidelines currently exist for lower limb arthroplasty in the United Kingdom.
• Variations in ERP implementation and adherence can impact patient outcomes and healthcare efficiency.

Purpose of the Study:

• To identify variations in Enhanced Recovery Programmes (ERPs) for lower limb arthroplasty across UK centres.
• To determine the level of adherence to local ERP policies in participating hospitals.
• To explore factors associated with reduced length of stay in lower limb arthroplasty patients.

Main Methods:

• A survey of hospitals performing elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) to gather details on their ERPs.
• An audit of 15 patients per centre to assess compliance with established ERP protocols.
• Statistical analysis to identify perioperative factors associated with length of stay.

Main Results:

• Significant variations in the content and detail of ERPs were observed among participating centres.
• Adherence to ERPs varied widely, ranging from 40-100% for TKA and 17-94% for THA.
• Perioperative dexamethasone, tranexamic acid, and early mobilization for TKA, along with procedures in teaching hospitals for THA, were associated with a reduced length of stay.

Conclusions:

• The study highlights considerable variation in practice and suboptimal compliance with local ERPs for lower limb arthroplasty.
• Establishing evidence-based guidelines, tailored to local capabilities, is essential for optimizing the patient care pathway.
• Improved adherence to standardized ERPs can enhance patient recovery and potentially reduce healthcare costs.