Abstract

IMMELMAN, RJ; DE VOS, JN  and  VENTER, JH. Comparing outcomes between enhanced recovery after surgery and traditional protocols in total hip arthroplasty: a retrospective cohort study. SA orthop. j. [online]. 2018, vol.17, n.1, pp.11-16. ISSN 2309-8309.  http://dx.doi.org/10.17159/2309-8309/2018/v17n1a1.

BACKGROUND: Traditionally, hip replacement surgery was associated with prolonged recovery and rehabilitation in a hospital setting. Prolonged stay is causing growing concern internationally, where there is an increased drive to cost-effective practice and a realisation that prolonged hospitalisation is not required and may be detrimental. Enhanced Recovery After Surgery (ERAS) protocols address this problem by advocating evidence-based multidisciplinary peri-operative management pathways associated with rapid recovery, without compromising safety. Despite proven efficacy, these protocols are not being implemented in most South African orthopaedic practices. METHODS: Data from two cohorts (80 patients) undergoing elective primary total hip arthroplasty were included. One group was rehabilitated according to a prolonged stay protocol and the other according to ERAS. Cohorts were matched according to demographics and comorbidities. The functional outcome was compared using the Oxford Hip Score. The 30-day readmission rate was compared to assess the safety of early discharge, and the length of stay of patients was compared. RESULTS: The readmission rate and Oxford Hip Scores showed no clinically significant difference between the cohorts. The length of stay was markedly decreased in the ERAS group. CONCLUSION: ERAS protocols can decrease the length of stay in elective total hip replacement without compromising patient safety or functional outcome. Level of evidence: Level 4.

Keywords : ERAS; enhanced recovery; rapid recovery; total hip replacement; arthroplasty.

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