Libby Lueck - Department of Orthopedic Surgery
Globally, orthopedic surgeries are among the most abundant operations; as these numbers continue to rise worldwide, enhanced recovery after surgery (ERAS) protocols are being increasingly considered for implementation. These protocols were originally introduced over 20 years ago, but studies revolving around ERAS for hip and/or knee surgeries didn’t come about until 2011, and it wasn’t until 2018 that ERAS was researched for spine, thorax, and elbow surgeries. In a systematic review of 174 eligible studies between 2012 and 2022, the outcomes of ERAS protocols in pre-, peri-, and postoperative settings were compared to more traditional protocols. The study evaluated elbow, knee and/or hip, thoracic, and spinal surgeries under the following ERAS protocols, but is not limited to these: complete patient education and preparation for the operation, prevention of bleeding or clotting, proper fluid and catheter management, and proper postoperative recovery.
Nearly all of the studies resulted in shorter hospital stays without increased complications or future hospital visits regardless of the surgical method used, surgeon, or follow-up time period. Notably, the pain management methods used reduced the need for opioids which in turn, reduced the rate of nausea/vomiting, stress, and other complications post-surgery. Moreover, the studies reported decreased blood loss due to the use of tranexamic acid (TXA), a medication that helps the blood to clot, thus reducing bleeding. There is extensive research supporting the benefits of ERAS, but the issue of regulation remains. Although the surgeon plays a key role in following these guidelines, it is imperative that the entire team, including surgeons, nurses, technicians, anesthesiologists, internists, physiatrists, physiotherapists, and nutritionists are all following the protocols for it to be successful. Currently, there are 200 or more facilities worldwide that have implemented ERAS protocols, with North America and Australia being the leaders and South America, Europe, and South Africa not far behind. ERAS could be the future of quick recovery rates and satisfied patients worldwide, but a plan for implementation must first be put in place.
References:
Mc Loughlin, Santiago & Alvarez, Adrian & Falcão, Luiz Fernando & Ljungqvist, Olle. (2020). The History of ERAS (Enhanced Recovery After Surgery) Society and its development in Latin America. Revista do Colégio Brasileiro de Cirurgiões. 47. 10.1590/0100-6991e-20202525.
Salamanna, Francesca et al. “Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review.” Journal of clinical medicine vol. 11,14 4222. 20 Jul. 2022, doi:10.3390/jcm11144222
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