Salamanna Francesca, Contartese Deyanira, Brogini Silvia, Visani Andrea, Martikos Konstantinos, Griffoni Cristiana, Ricci Alessandro, Gasbarrini Alessandro, Fini Milena
Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
J Clin Med. 2022 Jul 20;11(14):4222. doi: 10.3390/jcm11144222.
Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.
术后加速康复（ERAS）方案通过对患者治疗路径进行多模式优化、减少并发症、改善患者体验以及缩短住院时间，已在多个外科领域改善了治疗效果。然而，其在所有骨科领域的应用尚未得到一致认可，对于最佳实施流程也仍未达成共识。在此，我们评估了接受不同骨科手术的患者术前、术中和术后ERAS方案的关键要素、临床证据、测量指标及相关结果。我们在PubMed、Scopus和Web of Science核心合集数据库中进行了系统的文献检索，以识别2012年至2022年的临床研究。在检索到的1154项研究中，174项（25项关于脊柱手术、4项关于胸部手术、2项关于肘部手术以及143项关于髋部和/或膝部手术）被认为符合本综述的要求。结果显示，ERAS方案可改善骨科手术后的恢复情况，缩短住院时间（LOS）并降低再入院率。ERAS与非ERAS方案的对比研究还表明，患者的疼痛评分、满意度和活动范围均有所改善。尽管骨科手术中的ERAS方案安全有效，但未来有必要开展针对特定ERAS要素的研究，尤其是针对肘部、胸部和脊柱的研究，以优化这些方案。
