Enhanced recovery after surgery (ERAS): How does it affect the postoperative length of stay after unilateral primary total hip and knee arthroplasty in a private hospital?

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) has been shown to improve postoperative recovery and reduce postoperative length of stay (LOS) in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Our study aims to investigate whether the same promising results could be reproduced in a private hospital setting in Hong Kong. Materials and Methods: In total, 228 patients were included in the study cohort, with 117 patients from 2012 to 2014 being put in the conventional group and 111 patients from 2017 to 2018 being put in the ERAS group. All patients had undergone unilateral primary THA or TKA by a single surgeon at Hong Kong Sanatorium and Hospital. Primary outcome was postoperative LOS. Factors affecting LOS were also investigated. Results: No significant difference was found in all the baseline parameters between two groups of patients. In the ERAS group, mean LOS was significantly lower (3.28 ± 1.04 vs 5.16 ± 2.06 days, p<0.001) and a significantly higher proportion of patients were able to be discharged on or before postoperative day 3 (77.5% vs 13.7%, p<0.001). Significant difference in LOS was observed between patients staying in general and private ward (3.06 ± 0.59 vs 3.66 ± 1.46 days, p=0.003). Gender, age and nature of surgery (TKA vs THA) was not found to have significant effect on LOS. Conclusion: ERAS can also produce significant improvement in postoperative LOS compared to conventional practices for patients who underwent unilateral primary THA or TKA in a private hospital.