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Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis.
- Source :
- Postgraduate Medical Journal; Dec2018, Vol. 94 Issue 1118, p678-693, 16p
- Publication Year :
- 2018
-
Abstract
- <bold>Study Design: </bold>Systematic review with meta-analysis.<bold>Objectives: </bold>To evaluate the effects of enhanced recovery after surgery (ERAS) on the postoperative recovery of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA).<bold>Methods: </bold>The PubMed, Embase, Cochrane and ISI Web of Science databases were searched to identify literature including randomised controlled trials (RCTs), cohort studies and case-control studies through 2 May 2018. The analysed outcomes were mortality rate, transfusion rate, range of motion (ROM), 30-day readmission rate, postoperative complication rate and in-hospital length of stay (LOS).<bold>Results: </bold>A total of 25 studies involving 16 699 patients met the inclusion criteria and were included in the meta-analysis. Compared with conventional care, ERAS was associated with a significant decrease in mortality rate (relative risk (RR) 0.48, 95% CI 0.27 to 0.85), transfusion rate (RR 0.43, 95% CI 0.37 to 0.51), complication rate (RR 0.74, 95% CI 0.62 to 0.87) and LOS (mean difference (MD) -2.03, 95% CI -2.64 to -1.42) among all included trials. However, no significant difference was found in ROM (MD 7.53, 95% CI -2.16 to 17.23) and 30-day readmission rate (RR 0.86, 95% CI 0.56 to 1.30). There was no significant difference in complications of TKA (RR 0.84, 95% CI 0.34 to 2.06) and transfusion rate in RCTs (RR 0.66, 95% CI 0.15 to 2.88) between the ERAS group and the control group.<bold>Conclusions: </bold>This meta-analysis showed that ERAS significantly reduced the mortality rate, transfusion rate, incidence of complications and LOS of patients undergoing TKA or THA. However, ERAS did not show a significant impact on ROM and 30-day readmission rate. Complications after hip replacement are less than those of knee replacement, and the young patients recover better.<bold>Level Of Evidence: </bold>Level 1. [ABSTRACT FROM AUTHOR]
- Subjects :
- ARTHROPLASTY
META-analysis
SURGICAL complications
CHRONOLOGY
MOTION
CONVALESCENCE
INFORMATION storage & retrieval systems
MEDICAL databases
MEDICAL information storage & retrieval systems
MEDLINE
ONLINE information services
POSTOPERATIVE care
TOTAL hip replacement
TOTAL knee replacement
SYSTEMATIC reviews
REHABILITATION
Subjects
Details
- Language :
- English
- ISSN :
- 00325473
- Volume :
- 94
- Issue :
- 1118
- Database :
- Complementary Index
- Journal :
- Postgraduate Medical Journal
- Publication Type :
- Academic Journal
- Accession number :
- 134462545
- Full Text :
- https://doi.org/10.1136/postgradmedj-2018-136166