Nagra N S, Hamilton T W, Strickland L, Murray D W, Pandit H
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
*The British Orthopaedic Trainees Association, British Orthopaedic Association, London, UK.
Ann R Coll Surg Engl. 2017 Nov;99(8):631-636. doi: 10.1308/rcsann.2017.0124. Epub 2017 Aug 3.
Enhanced recovery programmes (ERPs) reduce patient morbidity and mortality, and provide significant cost savings by reducing length of stay. Currently, no uniform ERP guidelines exist for lower limb arthroplasty in the UK. The aim of this study was to identify variations in ERPs and determine adherence to local policy.
Hospitals offering elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) (23 and 22 centres respectively) contributed details of their ERPs, and performed an audit (15 patients per centre) to assess compliance.
Contrasting content and detail of ERPs was noted across centres. Adherence to ERPs varied significantly (40-100% for TKA, 17-94% for THA). Analysis identified perioperative use of dexamethasone, tranexamic acid and early mobilisation for TKA, and procedures performed in teaching hospitals for THA as being associated with a reduced length of stay.
This study highlights variation in practice and poor compliance with local ERPs. Given the proven benefits of ERPs, evidence-based guidelines in the context of local skillsets should be established to optimise the patient care pathway.
强化康复计划（ERPs）可降低患者的发病率和死亡率，并通过缩短住院时间显著节省成本。目前，英国尚无针对下肢关节置换术的统一ERP指南。本研究的目的是确定ERPs的差异，并确定对当地政策的遵守情况。
提供择期全膝关节置换术（TKA）和全髋关节置换术（THA）的医院（分别为23个和22个中心）提供了其ERPs的详细信息，并进行了一项审计（每个中心15名患者）以评估依从性。
各中心的ERPs在内容和细节上存在差异。对ERPs的遵守情况差异显著（TKA为40%-100%，THA为17%-94%）。分析确定，TKA围手术期使用地塞米松、氨甲环酸和早期活动，以及THA在教学医院进行的手术与缩短住院时间相关。
本研究突出了实践中的差异以及对当地ERPs的依从性较差。鉴于ERPs已被证实的益处，应制定基于当地技能组合的循证指南，以优化患者护理路径。
