Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Abstract

Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.

Perspectiva del personal de enfermería ante la práctica de cirugía segura

“…Según Salamanna et al, (2022), parte esencial de la cirugía segura es una adecuada historia clínica, que incluya información preoperatoria relevante del paciente para garantizar la calidad del servicio, la práctica profesional y la seguridad del paciente. Es así que, la Organización Mundial de la Salud implementó un registro tipo checklist para los pacientes que ingresan al quirófano, el cual está vinculado a la historia clínica.…”

The application of enhanced recovery after surgery (ERAS) in chronic rhinosinusitis patients undergoing endoscopic sinus surgery: A systematic review and meta-analysis

“…In future medical work, efforts should be made to popularize ERAS protocol in the field of otolaryngology, so that medical personnel in all departments of otolaryngology are fully aware of the possible clinical benefits of ERAS, which will lead to further implementation and development of ERAS within the perioperative period of CRS patients. It is worth noting that the implementation of a single ERAS element often does not result in a significant clinical benefit, but with the active efforts of multiple teams and multiple elements combined, we’ll reap much more benefits from the synergies [ 65 ]. This implies the importance of teamwork and the need to gain the patient’s understanding.…”

Socio-demographics, Causes of Injuries, and Rehabilitation Injury Categories in a Commercial Motorcycle Road-Related Orthopedics and Neurological Surgery Cohort in Eldoret, Kenya

“…Studies have shown each member of the interdisciplinary team collaborates, directly communicates and timely refers patients to each other to optimize their health and wellbeing by addressing patients' medical, surgical, functional and psychological needs concurrently (Rosen et al, 2018). Interdisciplinary teamwork approach to patients in the healthcare systems has been linked to better quality care and improved outcomes, multiple practitioners reduces medical errors, effective and efficient communication within an interdisciplinary team that reduces waiting time for interventions, faster treatment, reduced stalls of management within the team and patients frustrations; and prompt referrals, investigations and test results and reduced opportunity for condition worsening (Rosen et al, 2018), In addition interdisciplinary patients approach has been linked to reduced hospital stay due to timely surgical start times to prevent orthopedics and neurological surgery delays, improved quality care, quicker recovery and reduced average length of patients hospital stay (Salamanna et al, 2022). More so, collaboration and effective and efficient communication for patients care has been associated with patients better quality of life and healthcare workers high rate of job satisfaction (O'Daniel & Rosenstein, 2008).…”