髋膝关节置换国外ERAS研究

CE1.5ContactHoursEnhanced Recovery After Surgery forHip and Knee ReplacementsDavid P.Gwynne-Jones V Ginny Martin V Chris CraneBACKGROUND:Enhanced recovery after surgery (ERAS)hip and knee replacements (Ibrahim,Twaij,Giebaly,programs or hip and knee replacements have had a sig-Nizam,Haddad,2013;Kehlet Thienpont,2013).nificant effect on streamlining patient care with shorterPrograms are designed to prepare patients for,and re-stays,no increase in complications,and improved outcomesduce the total impact of,surgery,helping them recoverincluding reduced mortality.more quickly.These programs include preoperative in-PURPOSE:To compare outcomes following the introductionformation and optimization of comorbidities,anes-of an ERAS program for hip and knee replacements devel-thetic and postoperative analgesia,surgical technique,oped at our institution with a historical cohort of patients.perioperative blood management,early mobilization,rehabilitation,and discharge planning (KehletMETHODS:ERAS protocols were developed at our institu-Thienpoint,2013).Such programs take a whole-sys-tion for patients undergoing hip and knee joint replace-tem,evidence-based,multidisciplinary approachments.Key aspects were changes in preadmission,a new(Ibrahim et al.,2013;Kehlet Thienpoint,2013).Ineducation session,improved management of perioperativeorthopaedics,they may reduce mortality,averageanemia,standardized anesthetic guidelines,day of surgerylength of stay(ALOS),and perioperative complicationsmobilization,and improved discharge planning.The resultswithout an increase in complication or readmissionof the first 18 months(528 consecutive patients)were com-rates (Kearney,Jennrich,Lyons,Robinson,Berger,pared with those of a historical cohort of 507 patients from2011;Malviya et al.,2011;McDonald,Siegmeth,the 18 months prior to their introduction.Deakin,Kinninmonth,Scott,2012;WainwrightRESULTS:In the ERAS group,the mean age was 68.3 yearsMiddleton,2010).As there are approximately six timesfor patients who underwent hip replacement and 70.4 yearsmore elective hip and knee replacements performedper year in the United Kingdom than colorectal proce-for patients who underwent knee replacement.Thirty-twodures,the potential benefitsmay be greater(Wainwrightpercent of patients were ASA(American Society of Anesthe-Middleton,2010).siologists)Grades lll and IV.The average preoperative OxfordDespite the success of ERAS programs,there havescore was 11.The average length of stay (ALOS)fell frombeen few published results in Australasia(Keane et al.,5.6 to 4.3 days for patients who underwent hip replacement2012).We developed and implemented ERAS protocolsand from 5.7 to 4.8 days for patients who underwent kneeas part of a wider program-the Orthopaedic Patientreplacement(p <.001).Ninety-six percent of patients werePathway funded by the Ministry of Health,under thedischarged home.The 30-day readmission rate increasedElective Services Productivity and Workforce Program.from 3.2%to 5.5%(p =.065).