title: Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty.
abstract: BACKGROUND
  The enhanced recovery programme (ERP) is used to improve patient experience before, during and after an operation. Initially designed for colorectal surgery, it has now been adopted by many other disciplines, including orthopaedics. Where applicable, ERP has shown to be associated with less pain, reduced length of hospital stay and increased patient satisfaction in elective orthopaedic procedures. There is, however, a paucity of data regarding the use of ERP in fractured neck of femur (NOF) operations. Our aim was to investigate the effect of ERP on analgesic requirements and hospital length of stay during hemiarthroplasty.
  
  
  METHODS
  Consecutive notes of 100 patients who received a hemiarthroplasty for a fractured NOF were reviewed retrospectively. In one group (n = 50), patients received routine pre- and post-operative care; the second (n = 50) were on the ERP. All patients were previously mobile with an abbreviated mental test score of more than eight and lived in their own home.
  
  
  RESULTS
  With ERP, oral opiate consumption fell dramatically in the first three post-operative days (4.7 vs. 14.0 mg, p > 0.005). The use of patient-controlled analgesia (PCA) was also significantly reduced (odds ratio 0.16, p > 0.05). Although ERP had no statistically significant effect on length of stay (7 vs. 8.5 days, p = 0.2), it saw a greater proportion of patients being discharged back to their own home (25 vs. 19 patients, p < 0.05).
  
  
  CONCLUSIONS
  The ERP reduces post-operative oral opiates and PCA requirements in fractured NOF cases and by inference reduces pain. It does not appear to affect length of hospital stay in an acute unit.
authors.affiliation: James Paget University Hospital, Lowestoft, Great Britain. r.talboys@doctors.net.uk.
authors.forename: Rupert
authors.identifier: http://orcid.org/0000-0003-0033-9939
authors.initials: R
authors.lastname: Talboys
authors.affiliation: James Paget University Hospital, Lowestoft, Great Britain.
authors.forename: Mandy
authors.initials: M
authors.lastname: Mak
authors.affiliation: James Paget University Hospital, Lowestoft, Great Britain.
authors.forename: Nitin
authors.initials: N
authors.lastname: Modi
authors.affiliation: James Paget University Hospital, Lowestoft, Great Britain.
authors.forename: Nabil
authors.initials: N
authors.lastname: Fanous
authors.affiliation: James Paget University Hospital, Lowestoft, Great Britain.
authors.forename: Steven
authors.initials: S
authors.lastname: Cutts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000534:rehabilitation*; D005260:Female; D062785:Hemiarthroplasty / Q000379:methods / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: Enhanced recovery; Fractured; Hemiarthroplasty; Hip