Enhanced Recovery after Surgery Rehabilitation Protocol in the Perioperative Period of Orthopedics: A Systematic Review

Abstract

Purpose: Enhanced recovery after surgery (ERAS) is a surgical rehabilitation protocol of increasing interest to clinicians in recent years, with the aim of faster and better recovery of patients after surgery. Our main focus in this review is to analyze the effectiveness of ERAS rehabilitation protocols in orthopedic surgery. By comparing the post-operative recovery of patients receiving the ERAS rehabilitation program with that of patients receiving the conventional rehabilitation program, we observed whether the patients who have received the ERAS rehabilitation program could recover better and faster, thereby achieving the aim of a shorter hospital stay and reducing the incidence of complications.

Methods: We conducted the literature searches in PubMed, MEDLINE, Web of Science, Cochrane Reviews, EMBASE and other databases on clinical studies related to orthopedic surgery regarding the effectiveness of rehabilitation using ERAS rehabilitation protocols compared with conventional rehabilitation protocols. A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. If there was variability in the rehabilitation data of the patients between the two subgroups, it was considered that there was a difference in the rehabilitation effect of the ERAS rehabilitation protocol and the conventional rehabilitation protocol on the patients.

Conclusion: The application of ERAS rehabilitation protocols can shorten patients' hospital stay and reduce their expenses. In addition, patients with ERAS rehabilitation protocols will have fewer postoperative complications, while patients will have less postoperative pain than those with conventional rehabilitation, facilitating better postoperative recovery.

Keywords: enhanced recovery after surgery; orthopedics; rehabilitation; surgery; systematic review.

Figure 1

The inclusion process of the literature search.

Figure 2

(A): Risk of bias assessment in studies. (B): Risk of bias assessment in each study [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].

Figure 2

(A): Risk of bias assessment in studies. (B): Risk of bias assessment in each study [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].

Figure 3

(A): The forest plot for fracture surgery of length of hospitalization. (B): The forest plot for joint replacement surgery of length of hospitalization. (C):The forest plot for spine surgery of length of hospitalization [25,26,27,28,29,30,31,32,33,34,35,36,37,38].

Figure 3

(A): The forest plot for fracture surgery of length of hospitalization. (B): The forest plot for joint replacement surgery of length of hospitalization. (C):The forest plot for spine surgery of length of hospitalization [25,26,27,28,29,30,31,32,33,34,35,36,37,38].

Figure 4

(A): The forest plot for fracture surgery of complications. (B): The forest plot for joint replacement surgery of complications. (C):The forest plot for spine surgery of complications [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].

Figure 4

(A): The forest plot for fracture surgery of complications. (B): The forest plot for joint replacement surgery of complications. (C):The forest plot for spine surgery of complications [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].

Figure 5

(A): The forest plot for joint replacement surgery of VAS. (B): The forest plot for spine surgery of VAS [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].