Risk factors for complications and readmission after total hip or knee replacement with ERAS

The impact of enhanced rehabilitation after surgery (ERAS) on treatment quality and safety has been scarcely reported. The present study aimed to analyze rates of complications and readmission in the 3 months after total knee or hip replacement (TKR, THR) following an ERAS protocol, by stratifying patients according to surgery time.

A single-center multi-surgeon retrospective observational study was conducted on prospectively collected data. 1,299 primary THRs and 407 primary TKRs performed between October 2018 and November 2022 were included. Patients were grouped according to surgery duration: group A, ≤2 h; group B, >2 h. Data for perioperative results, surgical time, hospital length of stay, complications and readmissions within 90 days were collected.

1,235 THR patients (95%) were in group A and 64 (5.0%) in group B. The complication rate in THR was 0.8% overall: 0.4% in group A, versus 9.4% in group B (p < 0.0001). The readmission rate was 1.2%: 1.2% in group A, versus 6.3% in group B (p = 0.006). Mean hospital length of stay was 2.7 ± 1.4 days (range, 0-9). Longer surgical time correlated with longer stay (p = 0.033), later mobilization (p < 0.0001) and higher ASA score (p = 0.01). 358 TKR patients (88%) were in group A and 49 (12%) in group B. The complication rate in TKR was 0.5% overall, with no significant difference between groups. The readmission rate was 1%, with no significant difference between groups. Mean hospital stay was 3.2 ± 1.5 days (range, 1-9). Longer surgery time correlated with younger age (p < 0.0001) and later mobilization (p = 0.0001).

Longer surgical time was associated with a slightly higher complication rate and longer hospital stay in case of ERAS after THR or TKR. However, ERAS ensured treatment safety, with <4 days' mean hospital length of stay in a university hospital.

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