Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome
Abstract Background Enhanced recovery after surgery (ERAS) has rapidly gained popularity among hip or knee arthroplasty area which can decrease hospital length of stay (LOS). However, limited data exist regarding its safety and efficacy among intertrochanteric fracture patients. The purpose of this...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | http://link.springer.com/article/10.1186/s13018-019-1238-2 |
| _version_ | 1818002041415401472 |
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| author | Yan Kang Jianxing Liu Haihong Chen Wang Ding Jianqing Chen Bin Zhao Xiaofan Yin |
| author_facet | Yan Kang Jianxing Liu Haihong Chen Wang Ding Jianqing Chen Bin Zhao Xiaofan Yin |
| author_sort | Yan Kang |
| collection | DOAJ |
| description | Abstract Background Enhanced recovery after surgery (ERAS) has rapidly gained popularity among hip or knee arthroplasty area which can decrease hospital length of stay (LOS). However, limited data exist regarding its safety and efficacy among intertrochanteric fracture patients. The purpose of this study was to determine if LOS associated with intertrochanteric fracture patients can be improved following an existing orthopedic ERAS procedure. Methods We reviewed the outcomes of all patients who had been treated with the PFNA intramedullary fixation at our institution. Open fractures, metastatic pathological fractures, patients unable to walk independently before fracture and patients with Alzheimer's disease were excluded. A quasi-experimental study was adopted between patients treated in an ERAS after intramedullary fixation with those rehabilitated on a traditional pathway. Clinical and demographic data were collected among the two pathway cohorts including LOS, Harris hip scores (HHS), visual analog scale (VAS), and activity of daily living scale (ADL). Results A total of 100 intertrochanteric fracture patients (ERAS pathway 50 cases, traditional care pathway 50 cases) were selected between January 2016 and December 2017 met the inclusion criteria. ERAS procedure was associated with shorter LOS, lower postoperative VAS scores, reduced opioid consumption, earlier mobilization, significant improvement in the mean HHS scores at 3 months postoperatively, lower risk of complications, lower rates of readmission, and reoperation and higher likelihood of being discharged home. The mean LOS decreased from 8.21 ± 0.83 days to 5.82 ± 0.64 days after implementation of the evidence-based orthopedic ERAS pathway (p < 0.05). Conclusions This series of intertrochanteric fracture patients treated with the orthopedic ERAS procedure demonstrated that the procedure is capable of reducing LOS and preserving hip function without compromising functional outcome. This improvement was possible without a concomitant increase in postoperative complications and readmission rates. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| first_indexed | 2024-04-14T03:40:50Z |
| format | Article |
| id | doaj.art-c95b76f223e74f4aa3fd62245a32d3b8 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T03:40:50Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-c95b76f223e74f4aa3fd62245a32d3b82022-12-22T02:14:32ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2019-07-011411710.1186/s13018-019-1238-2Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcomeYan Kang0Jianxing Liu1Haihong Chen2Wang Ding3Jianqing Chen4Bin Zhao5Xiaofan Yin6Orthopaedic Department, Minhang Center Hospital, Fudan UniversityOrthopaedic Department, Minhang Center Hospital, Fudan UniversityOrthopaedic Department, Minhang Center Hospital, Fudan UniversityOrthopaedic Department, Minhang Center Hospital, Fudan UniversityOrthopaedic Department, Minhang Center Hospital, Fudan UniversityOrthopaedic Department, Minhang Center HospitalOrthopaedic Department, Minhang Center Hospital, Fudan UniversityAbstract Background Enhanced recovery after surgery (ERAS) has rapidly gained popularity among hip or knee arthroplasty area which can decrease hospital length of stay (LOS). However, limited data exist regarding its safety and efficacy among intertrochanteric fracture patients. The purpose of this study was to determine if LOS associated with intertrochanteric fracture patients can be improved following an existing orthopedic ERAS procedure. Methods We reviewed the outcomes of all patients who had been treated with the PFNA intramedullary fixation at our institution. Open fractures, metastatic pathological fractures, patients unable to walk independently before fracture and patients with Alzheimer's disease were excluded. A quasi-experimental study was adopted between patients treated in an ERAS after intramedullary fixation with those rehabilitated on a traditional pathway. Clinical and demographic data were collected among the two pathway cohorts including LOS, Harris hip scores (HHS), visual analog scale (VAS), and activity of daily living scale (ADL). Results A total of 100 intertrochanteric fracture patients (ERAS pathway 50 cases, traditional care pathway 50 cases) were selected between January 2016 and December 2017 met the inclusion criteria. ERAS procedure was associated with shorter LOS, lower postoperative VAS scores, reduced opioid consumption, earlier mobilization, significant improvement in the mean HHS scores at 3 months postoperatively, lower risk of complications, lower rates of readmission, and reoperation and higher likelihood of being discharged home. The mean LOS decreased from 8.21 ± 0.83 days to 5.82 ± 0.64 days after implementation of the evidence-based orthopedic ERAS pathway (p < 0.05). Conclusions This series of intertrochanteric fracture patients treated with the orthopedic ERAS procedure demonstrated that the procedure is capable of reducing LOS and preserving hip function without compromising functional outcome. This improvement was possible without a concomitant increase in postoperative complications and readmission rates. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.http://link.springer.com/article/10.1186/s13018-019-1238-2Intertrochanteric fractureEnhanced recovery after surgery (ERAS)Length of stay (LOS)Intramedullary fixationProximal femoral nail anti-rotation (PFNA) |
| spellingShingle | Yan Kang Jianxing Liu Haihong Chen Wang Ding Jianqing Chen Bin Zhao Xiaofan Yin Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome Journal of Orthopaedic Surgery and Research Intertrochanteric fracture Enhanced recovery after surgery (ERAS) Length of stay (LOS) Intramedullary fixation Proximal femoral nail anti-rotation (PFNA) |
| title | Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome |
| title_full | Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome |
| title_fullStr | Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome |
| title_full_unstemmed | Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome |
| title_short | Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome |
| title_sort | enhanced recovery after surgery eras in elective intertrochanteric fracture patients result in reduced length of hospital stay los without compromising functional outcome |
| topic | Intertrochanteric fracture Enhanced recovery after surgery (ERAS) Length of stay (LOS) Intramedullary fixation Proximal femoral nail anti-rotation (PFNA) |
| url | http://link.springer.com/article/10.1186/s13018-019-1238-2 |
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