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Meta-Analysis
. 2017 Dec;93(1106):736-742.
doi: 10.1136/postgradmedj-2017-134991. Epub 2017 Jul 27.

Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Shibai Zhu  1 , Wenwei Qian  1 , Chao Jiang  1 , Canhua Ye  1 , Xi Chen  1
Affiliations
Meta-Analysis

Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Shibai Zhu et al. Postgrad Med J. 2017 Dec.

Abstract

Objectives: To collect data of randomised controlled trials (RCTs) and clinical controlled trials (CCTs) for evaluating the effects of enhanced recovery after surgery on postoperative recovery of patients who received total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods: Relevant, published studies were identified using the following key words: arthroplasty, joint replacement, enhanced recovery after surgery, fast track surgery, multi-mode analgesia, diet management, or steroid hormones. The following databases were used to identify the literature consisting of RCTs or CCTs with a date of search of 31 December 2016: PubMed, Cochrane, Web of knowledge, Ovid SpringerLink and EMBASE. All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were postoperative length of stay (LOS), 30-day readmission rate, and total incidence of complications. RevMan5.2. software was adopted for the meta-analysis.

Results: A total of 10 published studies (9936 cases) met the inclusion criteria. The cumulative data included 4205 cases receiving enhanced recovery after surgery (ERAS), and 5731 cases receiving traditional recovery after surgery (non-ERAS). The meta-analysis showed that LOS was significantly lower in the ERAS group than in the control group (non-ERAS group) (p<0.01), and there were fewer incidences of complications in the ERAS group than in the control group (p=0.03). However, no significant difference was found in the 30-day readmission rate (p=0.18).

Conclusions: ERAS significantly reduces LOS and incidence of complications in patients who have had THA or TKA. However, ERAS does not appear to significantly impact 30-day readmission rates.

Keywords: enhanced recovery after surgery; meta-analysis; systematic review; total hip arthroplasty; total knee arthroplasty.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of  searches.
Figure 2
Figure 2
Comparison of the length of stay between the ERAS group and the control group. ERAS, enhanced recovery after surgery.
Figure 3
Figure 3
Comparison of the incidence of complications between the ERAS group and the control group.
Figure 4
Figure 4
Comparison of 30-day readmission rate between ERAS and control group.
Figure 5
Figure 5
Analysis of publication bias for postoperative complications from seven studies (funnel plot of standard error of log odds ratio vs odds ratio for the incidence of postoperative complications in ERAS group compared with non-ERAS group). ERAS, enhanced recovery after surgery.
See this image and copyright information in PMC

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