The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units—an implementation and follow-up at 1 year, 2010–2011: a report from the Musculoskeletal Audit, Scotland

Objective To establish whether a nationally guided programme can lead to more widespread implementation of enhanced recovery after surgery (ERAS), a well-established optimised care pathway for lower limb arthroplasty. Design In 2010, National Services Scotland’s Musculoskeletal Audit was asked to pe...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Archives of orthopaedic and trauma surgery 2013, Vol.133 (1), p.117-124
Hauptverfasser: Scott, Nicholas B., McDonald, David, Campbell, Jane, Smith, Richard D., Carey, A. Kate, Johnston, Ian G., James, Kate R., Breusch, Steffen J.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:Objective To establish whether a nationally guided programme can lead to more widespread implementation of enhanced recovery after surgery (ERAS), a well-established optimised care pathway for lower limb arthroplasty. Design In 2010, National Services Scotland’s Musculoskeletal Audit was asked to perform a ‘snapshot’ audit of the current peri-operative management of patients undergoing total hip and knee arthroplasty in all 22 Scottish orthopaedic units with an identical follow-up audit in 2011 after input and support from the national steering group. Population Audit 1 and audit 2 involved 1,345 and 1,278 patients, respectively. Results The number of Scottish units that developed an ERAS programme increased from 8 (36 %) to 15 (68 %). Units that included more ERAS patients had earlier mobilisation rates (146/474, 36 % ERAS patients mobilised same day vs. 34/873, 4 % non-ERAS; n  = 22 units, r  = 0.55, p  = 0.008) and shorter post-operative length of stay (median 4 days vs. ERAS, 5 days non-ERAS, n  = 22 units, r  = −0.64, p  = 0.001). ERAS knee arthroplasty patients had lower blood transfusion rates (5/205, 2 % vs. 51/399, 13 %, n  = 22 units, r  = −0.62, p  = 0.002). Units that restricted the use of IV fluids post-operatively had higher early mobilisation rates ( n  = 22 units, r  = 0.48, p  = 0.03) and shorter post-operative length of stay ( n  = 22 units, r  = −0.56, p  = 0.007). Reduced use of patient-controlled analgesia was also associated with earlier mobilisation ( n  = 22 units, r  = 0.49, p  = 0.02) and shorter length of stay ( n  = 22 units, r  = −0.39, p  = 0.07). Urinary catheterisation rates also dropped from 468/1,345 (35 %) in 2010 to 337/1,278 (26 %) in 2011 ( n  = 22 units, z  = 2.19, p  = 0.03). Conclusion A clinically guided and nationally supported process has proven highly successful in achieving a further uptake of enhanced recovery principles after lower limb arthroplasty in Scotland, which has resulted in clinical benefits to patients and reduced length of hospital stay.
ISSN:0936-8051
1434-3916
DOI:10.1007/s00402-012-1619-z