Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Deng, Qi-Feng; Gu, Hao; Peng, Wu-ya; Zhang, Qiong; Huang, Zhengdong; Zhang, Chao; Yu, Yun-Xiang

doi:10.1136/postgradmedj-2018-136166

Cited by 86 publications

(60 citation statements)

References 40 publications

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“…An evidence-based review of the individual components delivering a proposed pathway of enhanced recovery in spinal surgery is timely. We have proposed a multidisciplinary pathway based on the current best evidence in spinal surgery and ERAS society resources [3][4][5][6][7][8]47]. Prior proposed pathways have often concentrated on components critical to spinal surgery including minimally invasive surgery, multimodal analgesia, early mobility and perioperative nutrition.…”

Section: Discussionmentioning

confidence: 99%

“…We have chosen this method in order to answer the key question of "what happens when the complex intervention is implemented?". This method of evidence synthesis is in line with other published enhanced recovery reviews [3,5,7,15,16,41,42]. Meta-analyses will not be conducted due to the anticipated inherent methodological heterogeneity of the studies with regard to design, populations, procedures, and outcomes [43].…”

Section: Data Synthesismentioning

confidence: 92%

“…The authors performed this process by reviewing the current externally validated enhanced recovery protocols as recommended by the ERAS Society. We compared and contrasted the current published guidelines and reviews for gastrointestinal surgery, thoracic surgery, orthopedic surgery, and gynecological surgery [3][4][5][6][7][8]12]. We identified and applied the relevant components to the field of spinal surgery.…”

Section: Methodsmentioning

confidence: 99%

“…The aim of this complex intervention systematic review is to propose an evidence-based integrated enhanced recovery pathway specific to patients undergoing spinal surgery. We have identified 22 individual elements of enhanced recovery in spinal surgery in line with other standardized ERAS pathways and expert panel assessment [3][4][5][6][7][8][15][16][17][18] (see Additional file 1).…”

Section: Aims and Objectivesmentioning

confidence: 98%

“…A recent review of the effectiveness of the ERAS pathways in the UK concluded there was significant evidence that the programs could reduce the length of hospital stay without increasing readmissions [2]. There have been guidelines issued for multiple surgical subspecialties including colorectal, thoracic, gynecological, urological, and major arthroplasty surgery [3][4][5][6][7][8][9][10]. There is increasing research into the benefit of individual enhanced recovery elements and integrative protocols in spinal surgery.…”

Section: Introductionmentioning

confidence: 99%

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Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

et al. 2020

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Background: The best evidence-enhanced recovery care pathway is yet to be defined for patients undergoing spinal surgery. Minimally invasive surgery, multimodal analgesia, early mobilization, and early postoperative nutrition have been considered as critical components of enhanced recovery in spinal surgery (ERSS). The objective of this study will be to synthesize the evidence underpinning individual components of a proposed multidisciplinary enhanced recovery pathway for patients undergoing spinal surgery. Methods: This is the study protocol for a systematic review of complex interventions. Our team identified 22 individual care components of a proposed pathway based on clinical practice guidelines and published reviews. We will include systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled trials, and observational studies in adults or pediatric patients evaluating any one of the pre-determined care components. Our primary outcomes will be all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We will search the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The risk of bias for individual studies will be appraised using appropriate tools. A narrative synthesis will be provided with the information presented in the text and tables to summarize and explain the characteristics and findings of the included studies. Due to clinical and methodological heterogeneity, we do not anticipate to conduct meta-analyses. Confidence in cumulative evidence for each component of care will be classified according to the GRADE system.Discussion: This systematic review will identify, evaluate, and integrate the evidence underpinning individual components of a pathway for patients undergoing spinal surgery. The formation of an evidence-based pathway will allow for the standardization of clinical care delivery within the context of enhanced recovery in spinal surgery. Systematic review registration: PROSPERO CRD42019135289

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Section: Discussionmentioning

confidence: 99%

Section: Data Synthesismentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Aims and Objectivesmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

et al. 2020

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Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

et al. 2020

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IMPORTANCE The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.OBJECTIVE To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. EXPOSURES Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. MAIN OUTCOMES AND MEASURES The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. RESULTS During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%];OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR,[4][5][6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). CONCLUSIONS AND RELEVANCEAn increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.

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The knee prosthesis constraint dilemma: Biomechanical comparison between varus‐valgus constrained implants and rotating hinge prosthesis. A cadaver study

León-Román¹,

García-Mato

López-Torres

et al. 2020

Journal Orthopaedic Research

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The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses (CCK) is a matter of discussion in revision knee arthroplasty. The objectives of this study are to compare the tibial rotation of both implants and validate the use of inertial sensors with optical tracking system as movement measurement tools. A total of 16 cadaver knees were used. Eight knees were replaced using a RHK (Endomodel LINK), and the remaining eight received a CCK prosthesis (LCCK, Zimmer). Tibial rotation range of motion was measured in full extension and at 30°, 60°, and 90° of flexion, with four continuous waveforms for each measurement. Measurements were made using two inertial sensors with specific software and compared with measurements obtained using the gold standard technique ‐ the motion capture camera. The comparison of the accuracy of both measurement methods showed no statistically significant differences between inertial sensors and motion capture cameras, with p > .1; the mean error for tibial rotation was 0.21°. Tibial rotation in the RHK was significantly greater than in the CCK (5.25° vs. 2.28°, respectively), p < .05. We have shown that RHK permit greater tibial rotation, being closer to physiological values than CCKs. Inertial sensors have been validated as an effective and accurate method of measuring knee movement. The clinical significance: RHK appears to represent a lower constriction degree than CCK systems.

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Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Cited by 86 publications

References 40 publications

Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

The knee prosthesis constraint dilemma: Biomechanical comparison between varus‐valgus constrained implants and rotating hinge prosthesis. A cadaver study

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