Short‐Term Outcomes of Enhanced Recovery after Surgery (<scp>ERAS</scp>) for Ankle Fracture Patients: A Single‐Center Retrospective Cohort Study

Yao, Yuefeng; Li, Guoqing; Li, Jing; Liu, Su; Chen, Yixiao; Deng, Jiapeng; Wei, Yihao; Gao, Liang; Wang, Deli; Zeng, Hui

doi:10.1111/os.13621

Cited by 3 publications

(3 citation statements)

References 51 publications

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“…Patients in the high-compliance group demonstrated a significantly shorter discharge time after surgery than those in the low-compliance group ( P < 0.05). However, we identified no significant difference in the total medical costs, LOS, and the elapse time between admission and surgery, contradicting previous evidence that the ERAS protocol could shorten the LOS [ 9 , 29 ] and reduce medical costs [ 30 , 31 ]. This finding was attributed to the admission of patients over the weekend (36 patients, 41% of cases) and to the fact that tension blisters around the wrist joint may delay the time to surgery (25 patients corresponding to 28.4% of cases, presented with swelling and blisters around the wrist.…”

Section: Discussioncontrasting

confidence: 99%

Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study

Mu Er Ti Zha,

Sun,

et al. 2023

J Orthop Surg Res

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Background Distal radius fractures (DRF) account for one in five bony injuries in both primary and secondary trauma care. Enhanced recovery after surgery (ERAS) has been adopted successfully to improve clinical outcomes in multiple surgical disciplines; however, no study has investigated the effect of different degrees of compliance with ERAS protocol on short-term outcomes following distal radius surgery. We aimed to analyze whether different degrees of compliance with the ERAS pathway are associated with clinical improvement following surgery for DRF. Methods We retrospectively analyzed all consecutive patients with ERAS who underwent surgery for DRF at our department between May 2019 and October 2022. Their pre-, peri-, and post-operative compliance with the 22 elements of the ERAS program were assessed. We compared parameters between low- (< 68.1%) and high-compliance (> 68.1%) groups, including patient complications, total length of hospitalization, discharge time after surgery, hospital costs, time taken to return to preinjury level performance level, number of visual analogue scale (VAS) pain scores > 3 points during hospitalization, disabilities of the arm, shoulder and hand (DASH) scores. We performed multiple linear regression analyses to assess the impact of ERAS compliance on the postoperative function level (DASH scores). Results No significant differences were detected between the high- and low-compliance groups with respect to demographics, including sex, age, body mass index (BMI), and comorbidities (P > 0.05). We observed significant differences between the high- and low-compliance groups in terms of the DASH score (32.25 ± 9.97 vs. 40.50 ± 15.65, p < 0.05) at 6 months postoperatively, the discharge time after surgery (2.45 ± 1.46 vs. 3.14 ± 1.50, p < 0.05), and number of times when the VAS pain score was > 3 points during hospitalization (0.88, [0.44, 1.31], p < 0.05). Our study demonstrated a significant negative association between ERAS compliance and the function level of patients postoperatively (DASH scores) when adjusted for age, comorbidity, sex, and BMI. Conclusions This study provided a realistic evaluation and comparison of the ERAS protocol among patients with DRF and can guide clinical decision making. The ERAS protocol may improve outcomes after surgery, with high postoperative function levels and reduced pain and discharge time after surgery, without increased complication rates or hospital costs.

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Section: Discussioncontrasting

confidence: 99%

Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study

Mu Er Ti Zha,

Sun,

et al. 2023

J Orthop Surg Res

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“…Patients in the highcompliance group demonstrated signi cantly different discharge time after surgery than those in the lowcompliance group (P < 0.05). However, we identi ed no signi cant difference in the total medical costs, LOS, and the elapse time between admission and surgery, which may contradict existing evidence that the ERAS protocol could shorten the LOS [8, 28] and reduce medical costs [29,30]. This nding was attributed to the patient being admitted on weekends, and tension blisters around the wrist joint may delay the operation time.…”

Section: Discussioncontrasting

confidence: 74%

Impact of ERAS Compliance on the Short-Term Outcomes for Distal Radius Surgery: A Single-Center Retrospective Study

Zha,

Sun,

et al. 2023

Preprint

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Background Distal radius fractures (DRF) account for one in five bony injuries in both primary and secondary trauma care. Enhanced recovery after surgery (ERAS) has been adopted successfully for improvement and efficacy in numerous diseases; however, no study has demonstrated the different degrees of ERAS compliance on the short-term outcomes for distal radius surgery. We aimed to analyze whether different compliance degrees to the ERAS pathway are associated with improvement in patients with DRF. Methods We analyzed all consecutive patients with ERAS who underwent surgery for DRF at our department between May 2019 and October 2022 retrospectively. Their pre-, peri-, and post-operative compliance with the 22 elements of the ERAS program were assessed. We compared patient complications, the total length of hospitalization, the discharge time after surgery, hospital costs, times for return to preinjury level, times of the visual analogue scale (VAS) pain score > 3 points during hospitalization, disabilities of the arm, shoulder and hand (DASH) scores, and other parameters between low- (< 68.1%) and high-compliance (> 68.1%) groups. We performed multiple linear regression equations to assess the impact of ERAS compliance on the function level of the patients postoperatively (DASH scores). Results No significant differences were detected between the high- and low-compliance groups, with respect to the demographics, including the sex, age, body mass index (BMI), and comorbidity (P > 0.05). We observed significant differences between the high- and low-compliance groups in terms of the DASH score (32.25 ± 9.97 vs. 40.50 ± 15.65, p < 0.05) at 6 months postoperatively, the discharge time after surgery (2.45 ± 1.46 vs. 3.14 ± 1.50, p < 0.05), and times of VAS pain scores > 3 points during hospitalization (0.88, (0.44, 1.31), p < 0.05). Our study demonstrated a significant negative association between ERAS compliance and the function level of the patients postoperatively (DASH scores) when adjusted for the age, comorbidity, sex, and BMI. Conclusion This study can provide a realistic evaluation and comparison of the ERAS protocol among patients with DRF and eventually guide clinical decision making. The ERAS protocol might improve the medical quality and efficacy with high function levels, less pain and time after surgery without increased complication rate and hospital cost.

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“…LWB, as the traditional post‐operative fracture rehabilitation program, has a high level of safety and is effective in avoiding the loss of reduction or fixation failure after surgery, thus reducing the risk of secondary surgery. In contrast, LWB may affect the recovery of patients' ankle function [ 14 , 15 ], and it may bring a heavier financial burden to patients, as LWB requires a longer rehabilitation time [ 16 , 17 , 18 ]. Therefore, researchers have recently begun to focus on the application of EWB in post‐operative ankle fracture rehabilitation programmes, considering that EWB can accelerate the speed of post‐operative ankle function recovery compared to LWB and enable patients to return to work/daily life earlier [ 6 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of early weight‐bearing and later weight‐bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta‐analysis of randomised controlled trials

Chen,

Ye,

et al. 2024

Journal of Foot and Ankle Research

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ObjectiveThis systematic review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle function scores, time to return to work/daily life and complication rates.MethodsThe China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight‐bearing interventions for post‐operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta‐analyses using Review Manager 5.3. Based on the time points at which post‐operative ankle function was reported in the studies included in this paper, we decided to perform a meta‐analysis of ankle function scores at 6 weeks post‐operatively, 12 weeks post‐operatively, 24–26 weeks post‐operatively and 1 year post‐operatively.ResultsA total of 11 papers, comprising 862 patients, were included. Meta‐analysis indicated that patients receiving early weight‐bearing interventions, which referred to weight‐bearing for 6 weeks post‐operatively, experienced enhancements in ankle function scores (Olerud–Molander score, AOFAS score or Baird–Jackson score) at various post‐operative milestones: 6 weeks (SMD = 0.69, 95% CI: 0.49–0.88 and p < 0.01), 12 weeks (SMD = 0.57, 95% CI: 0.22–0.92 and p < 0.01) and the 24–26 weeks range (SMD = 0.52, 95% CI: 0.20–0.85 and p < 0.01). The results of subgroup analyses revealed that the effects of early weight‐bearing interventions were influenced by ankle range‐of‐motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD = −2.74, 95% CI: −3.46 to −2.02 and p < 0.01), with no distinct elevation in the incidence of complications (RR = 1.49, 95% CI: 0.85–2.61 and p > 0.05).ConclusionThe results showed that early weight bearing is effective in improving ankle function among post‐operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.

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Short‐Term Outcomes of Enhanced Recovery after Surgery (ERAS) for Ankle Fracture Patients: A Single‐Center Retrospective Cohort Study

Cited by 3 publications

References 51 publications

Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study

Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study

Impact of ERAS Compliance on the Short-Term Outcomes for Distal Radius Surgery: A Single-Center Retrospective Study

The effect of early weight‐bearing and later weight‐bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta‐analysis of randomised controlled trials

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