Enhanced Recovery after Surgery (ERAS): An Orthopaedic Perspective

Abstract

Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery.

Enhanced recovery after surgery: the future of elective arthroplasty?

“…(4,12) This sets discharge expectations, creating a "length of stay boundary". Additionally, education aims to psychologically prepare patients by setting expectations of postoperative pain and discomfort.…”

“…(4,6,10) In addition, perioperative local anaesthetic infiltration around joints reduces pain and facilitates prompt ambulation. Hence, early discharge can be achieved without risking adverse outcomes.…”

“…(2,11) Uptake has been slow, often due to organisational inefficiency and multidisciplinary resistance to change. (3,4) The Components of ERAS Enhanced Recovery is most effective as a pre-emptive protocol, optimising the entire surgical pathway ( Figure 1). (9) This pathway can be applied to all patients with modifications to meet specific needs, empowering the patient to become an active participant in their recovery.…”

“…(1) The end goal is always to reduce length of stay and maximise rehabilitation that may be hindered by the hospital environment. (4,9) However, a key question is whether striving for earlier patient discharge is a desirable or even a beneficial goal. There was concern that premature discharge could increase complication rates, resulting in a rise in readmission of up to 13% and reduced patient satisfaction.…”

“…(2) ERAS was pioneered in the late 1990s by Kehlet in colorectal surgery as a response to the inadequacy of "unimodal responses to multimodal perioperative morbidity". (3,4) A General Overview ERAS encompasses a set of approaches and values aimed at patients undergoing major surgery. Many of the principles revolve around two questions: "why are surgical patients at risk?"…”