Enhanced Recovery Programme for Total Knee Replacement to Reduce the Length of Hospital Stay

• Main Authors: Amitabh J Dwyer, William Thomas, Simon Humphry, Paul Porter
• Format: Article
• Language: English
• Published: SAGE Publishing 2014-08-01
• Series: Journal of Orthopaedic Surgery
• Online Access: https://doi.org/10.1177/230949901402200206

Purpose. To compare the length of hospital stay in patients undergoing primary total knee replacement (TKR) with or without enhanced recovery (ER) programme. Methods. Medical records of 57 and 55 consecutive patients who underwent primary TKR with or without ER programme, respectively, were reviewed. 17 men and 40 women aged 43 to 87 (mean, 70) years with ER programme were compared with 22 men and 33 women aged 53 to 90 (mean, 73) years without ER programme in terms of the preoperative haemoglobin level, American Association of Anesthesiologists (ASA) physical status grading, body mass index (BMI), and length of hospital stay. Results. The length of hospital stay was significantly shorter in the ER than non-ER groups in overall patients (6 vs. 7.8 days, p=0.0003), in patients with preoperative haemoglobin level of ⩾14 g/dl (5.4 vs. 7.7 days, p=0.02), in patients with preoperative haemoglobin level of ±14 g/dl (6.2 vs. 7.7 days, p=0.02), in patients with ASA grades 1 and 2 (5.6 vs. 7.6 days, p=0.01), in patients with ASA grade 3 (6.4 vs. 8.2 days, p=0.01), in patients with BMI of ±30 kg/m 2 (6 vs. 8.1 days, p=0.0061), and in patients with BMI of ⩾30 kg/m 2 (5.9 vs. 7.5 days, p=0.0006). Complications were noted in 4 ER patients and 5 non-ER patients. Conclusion. ER programmes are readily transferable to patients undergoing TKR and significantly reduced the length of hospital stay.