title: Enhanced Recovery After Surgery in elective hip and knee arthroplasty reduces length of hospital stay.
abstract: BACKGROUND
  Standardized perioperative care within an Enhanced Recovery After Surgery (ERAS) programme aims to reduce postoperative morbidity and length of hospital stay (LOS). This study evaluated the effect of ERAS in patients undergoing elective, primary total hip and knee arthroplasty (THA and TKA) in a New Zealand public hospital.
  
  
  METHODS
  Data collected prospectively on patients who had undergone THA and TKA in an ERAS programme (ERAS: August-December 2013) were compared to a retrospective cohort of patients managed in a traditional perioperative care environment (control: June-August 2012). The Breakthrough Series Model for Improvement provided a framework to implement components of the ERAS protocol. The primary outcome was median LOS. Secondary outcomes included 30-day readmission rates, complications and cost.
  
  
  RESULTS
  There were 206 patients who met the eligibility criteria (106 ERAS, 100 control). There were no significant differences in baseline characteristics. After the implementation of ERAS, median LOS was reduced by 1 day (5 control versus 4 ERAS; P < 0.001). Short-term complications were similar (P = 0.372) as were readmission rates (P = 0.258). Cost analysis identified ERAS patients to have reduced cost overall.
  
  
  CONCLUSIONS
  ERAS in THA and TKA has been shown to be safe and effective in improving recovery through shorter hospital stay.
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.|Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Marinus D J
authors.initials: MD
authors.lastname: Stowers
authors.affiliation: Department of Orthopaedics, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Lavell
authors.initials: L
authors.lastname: Manuopangai
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.|Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
authors.affiliation: Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Jonathon R
authors.initials: JR
authors.lastname: Gray
authors.affiliation: Department of Orthopaedics, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Brendan
authors.initials: B
authors.lastname: Coleman
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.|Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Munro
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D007902:Length of Stay / Q000639:trends*; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors
keywords: arthroplasty; enhanced recovery after surgery; orthopaedic surgery; perioperative care