The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units--an implementation and follow-up at 1 year, 2010-2011: a report from the Musculoskeletal Audit, Scotland.
OBJECTIVE
To establish whether a nationally guided programme can lead to more widespread implementation of enhanced recovery after surgery (ERAS), a well-established optimised care pathway for lower limb arthroplasty.


METHODS
In 2010, National Services Scotland's Musculoskeletal Audit was asked to perform a 'snapshot' audit of the current peri-operative management of patients undergoing total hip and knee arthroplasty in all 22 Scottish orthopaedic units with an identical follow-up audit in 2011 after input and support from the national steering group.


METHODS
Audit 1 and audit 2 involved 1,345 and 1,278 patients, respectively.


RESULTS
The number of Scottish units that developed an ERAS programme increased from 8 (36 %) to 15 (68 %). Units that included more ERAS patients had earlier mobilisation rates (146/474, 36 % ERAS patients mobilised same day vs. 34/873, 4 % non-ERAS; n = 22 units, r = 0.55, p = 0.008) and shorter post-operative length of stay (median 4 days vs. ERAS, 5 days non-ERAS, n = 22 units, r = -0.64, p = 0.001). ERAS knee arthroplasty patients had lower blood transfusion rates (5/205, 2 % vs. 51/399, 13 %, n = 22 units, r = -0.62, p = 0.002). Units that restricted the use of IV fluids post-operatively had higher early mobilisation rates (n = 22 units, r = 0.48, p = 0.03) and shorter post-operative length of stay (n = 22 units, r = -0.56, p = 0.007). Reduced use of patient-controlled analgesia was also associated with earlier mobilisation (n = 22 units, r = 0.49, p = 0.02) and shorter length of stay (n = 22 units, r = -0.39, p = 0.07). Urinary catheterisation rates also dropped from 468/1,345 (35 %) in 2010 to 337/1,278 (26 %) in 2011 (n = 22 units, z = 2.19, p = 0.03).


CONCLUSIONS
A clinically guided and nationally supported process has proven highly successful in achieving a further uptake of enhanced recovery principles after lower limb arthroplasty in Scotland, which has resulted in clinical benefits to patients and reduced length of hospital stay.
Departments of Anaesthesia and Rehabilitation, Golden Jubilee National Hospital, Clydebank G81 4HX, UK. nickbscott@msn.com
Nicholas B
NB
Scott
David
D
McDonald
Jane
J
Campbell
Richard D
RD
Smith
A Kate
AK
Carey
Ian G
IG
Johnston
Kate R
KR
James
Steffen J
SJ
Breusch
D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology* / Q000601:surgery; D008485:Medical Audit; D011182:Postoperative Care; D020127:Recovery of Function; D012606:Scotland / Q000453:epidemiology