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Enhanced recovery protocol may reduce mortality rates following THA, TKA
The mortality rate found was 1.1% less with the new protocol than the traditional protocol.
A study of more than 4,500 consecutive total hip and knee arthroplasty procedures showed that an enhanced recovery program was associated with a significant reduction in mortality rates in patients.
“We have shown a real survival benefit following the introduction of an enhanced recovery program in our hospital,” Terence Savaridas, FRCS, of the Northern Deanery Orthopaedic Training Programme, located in Newcastle, United Kingdom, said in a presentation. “This supports the use of enhanced recovery programs for hip and knee replacements,” Savaridas said.
The research also noted that the enhanced recovery program led to a shortened hospital stay, as well as reduced overall postoperative complications in these patients.
Savaridas and colleagues evaluated 3,000 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) who were treated with the traditional protocol and another 1,500 patients who underwent THA or TKA and were treated with the enhanced recovery program. They evaluated survival benefits in both groups at 2 years postoperatively.
“These employ multidisciplinary practices with the aim to reduce the amount of stress associated with surgery and to minimize systemic upsets to the patient,” Savaridas said of the enhanced recovery practices. “Patients are admitted on the same day of the procedure. They are encouraged to walk theater. The intended procedure is performed. Urine catheters are avoided so as not to impede early mobilization. Local anesthetic is administrated at the end of the procedure, and patients are encouraged to mobilize early.”
According to the abstract, the mortality rate at 2 postoperative years was 3.8% for the traditional protocol cohort and 2.7% for the enhanced recovery group.
“The survival benefit is sustained in the longer term, and may even be increased,” he said during his presentation. The survival rates at up to 3.7 years postoperatively were significantly better in patients utilizing an enhanced recovery protocol, he noted.
“The reason for this prolonged beneficial effect is not clearly understood,” Savaridas said. “We suggest that this may be due to reduction in surgical stress and associated morbidity, the reduction of postoperative complications, the reduced need for perioperative transfusions, and the reduced hospital length of stay.”
The work of Savaridas and colleagues suggests that the use of multimodal techniques in patients who undergo THA and TKA may become more routine.
“Enhanced recovery has proven clinical benefits,” Savaridas said during his presentation. “It has been shown that it leads to earlier functional recovery,” he said. – by Christian Ingram
- References:
- Savaridas T. Paper #116. Presented at: British Orthopaedic Association Congress; Oct. 1-4, 2013. Birmingham, England.
- Savaridas T. Acta Orthop. 2013;doi: 10.3109/17453674.2013.771298. Epub 2013 Jan 31.
- For more information:
- Terence Savaridas, MD, can be reached at Northern Deanery Orthopaedic Training Programme, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne, United Kingdom; email: tsavaridas@doctors.net.uk.
Disclosure: Savaridas has no relevant financial disclosures.