IMPORTANCE The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.
OBJECTIVE To assess the association of use of the ERAS protocols with complications in
patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study included
patients recruited from 131 centers in Spain from October 22 through December 22, 2018.
All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients
were stratified between those treated in a self-designated ERAS center (ERAS group) and
those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15
through September 15, 2019.
EXPOSURES Total hip or knee arthroplasty and perioperative management. Sixteen individual
ERAS items were assessed in all included patients, whether they were treated at a center that
was part of an established ERAS protocol or not.
MAIN OUTCOMES AND MEASURES The primary outcome was postoperative complications
within 30 days after surgery. Secondary outcomes included length of stay and mortality.
RESULTS During the 2-month recruitment period, 6146 patients were included (3580 women
[58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients
(11.1%) presented with postoperative complications. No differences were found in the
number of patients with overall postoperative complications between ERAS and non-ERAS
groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer
patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%];
OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS
protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among
the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications
(144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to
severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84;
P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR,
0.97; 95% CI, 0.96-0.99; P < .001).