Impact of an Enhanced Recovery Protocol on Postoperative Outcomes After Elective Arthroplasty

Abstract

The prevalence of osteoarthritis continues to increase, driven by our ageing population and the growing obesity epidemic, leading to a rise in arthroplasties. Enhanced recovery programmes have been developed to optimise perioperative care and reduce length of stay (LOS). Our aim was to investigate the effect of an enhanced perioperative protocol at a high-volume regional elective hospital on readmission rate, LOS and adverse events.

We compared elective arthroplasties from June to December 2022 (cycle 1, pre-protocol) to those from the same period in 2023 (cycle 2, post-protocol). Data included demographics, surgical procedures, and perioperative management, with a primary outcome of 30-day readmissions and secondary outcomes of revisions, LOS, and postoperative complications.

Cycle 1 included 973 patients, mean age 69.9, standard deviation (SD 9.8), and cycle 2 included 1114 patients, mean age of 69.2 (SD 10). The mean LOS decreased from 2.26 days (SD 1.73) to 1.95 days (SD 2.67) (p<0.01), with 5.1% discharged on the day of surgery. Our 30-day readmission rate post intervention was 2.3% in cycle 2 compared to 0.6%, (p<0.01). There were no inpatient mortalities on first admission, however 1 reported death during readmission in cycle 2. There was no difference in surgical site infections (1.2% compared to 1.1%, p=0.74) and two cases of pulmonary embolism in cycle 2.

The 24-hour arthroplasty perioperative protocol effectively reduced LOS, there was a small increase in 30-day readmissions.