Challenges to the orthopaedic arthroplasty enhanced recovery programme

Area of Science:

• Orthopedic Surgery
• Enhanced Recovery Programs
• Arthroplasty

Background:

• Enhanced recovery after surgery (ERAS) programs aim to optimize patient recovery and reduce hospital stays following major orthopedic procedures.
• Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common procedures with significant recovery periods.
• Identifying factors that impede timely discharge is crucial for improving ERAS program efficiency.

Purpose of the Study:

• To investigate pre- and postoperative factors associated with prolonged hospital stays in patients undergoing TKA and THA.
• To identify the primary reasons for delayed discharge in patients managed under an enhanced recovery pathway.

Main Methods:

• Retrospective study design.
• Analysis of 109 patients who underwent total knee or hip arthroplasty.
• Evaluation of pre- and postoperative data to identify factors influencing length of hospital stay.

Main Results:

• Only 56% of patients (61 out of 109) were ready for discharge by the fifth postoperative day.
• The most frequent causes for delayed discharge were identified as wound oozing, postoperative medical complications, and failure to achieve physiotherapy milestones.
• These factors significantly contributed to extended hospital stays, despite adherence to the enhanced recovery program.

Conclusions:

• Enhanced recovery programs for TKA and THA may not consistently achieve the goal of early discharge for all patients.
• Addressing wound management, optimizing postoperative medical care, and ensuring timely physiotherapy progress are critical for reducing length of stay.
• Further research is needed to refine ERAS protocols and mitigate common barriers to early discharge in arthroplasty patients.