Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada.
Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada.
Orthop Traumatol Surg Res. 2019 Nov;105(7):1237-1243. doi: 10.1016/j.otsr.2019.08.013. Epub 2019 Oct 3.
An attractive option to reduce hospital length of stay (LOS) after hip or knee joint replacement (THA, TKA) is to follow the Enhanced Recovery After Surgery principles (ERAS) to improve patient experience to a level where they will feel confident to leave for home earlier. The objective of this study was to evaluate the implementation of short-stay protocol following the ERAS principles.
We hypothesized that our ERAS THA and TKA short-stay protocol would result in a lower complication rate, shorter hospital LOS and reduced direct health care costs compared to our standard procedure.
We compared the complications rated according to Clavien-Dindo scale, hospital LOS and costs of the episode of care between a prospective cohort of 120 ERAS short-stay THA or TKA and a matched historical control group of 150 THA or TKA.
Significantly lower rate of Grade 1 and 2 complications in the ERAS short-stay group compared with the standard group (mean 0.8 vs 3.0, p<0.001). No difference was found between the 2 groups for Grade 3, 4, or 5 complications. The mean hospital LOS for the ERAS short-stay group decreased by 2.8 days for the THAs (0.1 vs 2.9 days, p<0.001) and 3.9 days for the TKAs (1.0 vs 4.9 days, p<0.001). The mean estimated direct health care costs reduction with the ERAS short-stay protocol was 1489 CAD per THA and 4158 CAD per TKA.
In many short-stay protocols, focus has shifted from ERAS goals of a reduction in complications and improved recuperation to use length of stay as the main factor of success. Implementation of an ERAS short-stay protocol for patients undergoing THA or TKA at our institution resulted not only in reduced hospital LOS, but also in improved patient care and reduced direct health care costs.
Level II.
减少髋关节或膝关节置换术后住院时间（LOS）的一个有吸引力的选择是遵循术后强化康复（ERAS）原则，以提高患者的体验水平，使他们有信心更早地回家。本研究的目的是评估在 ERAS 原则下实施短期住院协议的效果。
我们假设，与我们的标准程序相比，我们的 ERAS 髋关节和膝关节置换术短期住院协议将导致较低的并发症发生率、较短的住院 LOS 和降低的直接医疗保健成本。
我们比较了根据 Clavien-Dindo 量表评定的并发症发生率、住院 LOS 和治疗期间的费用，将 120 例 ERAS 短期髋关节或膝关节置换术的前瞻性队列与 150 例髋关节或膝关节置换术的匹配历史对照组进行比较。
与标准组相比，ERAS 短期住院组的 1 级和 2 级并发症发生率显著降低（平均 0.8 对 3.0，p<0.001）。两组之间 3 级、4 级或 5 级并发症无差异。ERAS 短期住院组的平均住院 LOS 减少了 2.8 天（0.1 对 2.9 天，p<0.001）和 3.9 天（1.0 对 4.9 天，p<0.001）。实施 ERAS 短期住院协议后，平均直接医疗保健成本每例髋关节置换术降低 1489 加元，每例膝关节置换术降低 4158 加元。
在许多短期住院协议中，重点已经从 ERAS 减少并发症和改善康复的目标转移到将住院时间作为成功的主要因素。在我们机构中，为接受髋关节或膝关节置换术的患者实施 ERAS 短期住院协议，不仅缩短了住院时间，还改善了患者的护理，并降低了直接医疗保健成本。
2 级。
