Enhanced Recovery After Surgery for Hip and Knee Patients

Press release from Southern DHB on 28 May 2017

Results of 18-month Southern DHB trial published in international journal this month.

Shorter hospitals stays, lower use of rehabilitation facilities and high patient satisfaction are among the benefits of new hip and knee replacement surgery protocols put in place at Southern DHB.

Results of an 18-month trial of the Enhanced Recovery After Surgery (ERAS) protocols at Orthopaedic wards of Dunedin Hospital and Southland Hospital are reported in an academic paper published this month in the international journal Orthopaedic Nursing. Authored by Southern DHB Orthopaedic Surgeon David Gwynne-Jones, Clinical Coordinator Ginny Martin, and Programme Manager Orthopaedic Pathway Programme Chris Crane, the paper looks at the recovery of 528 patients, compared to 507 in the historic control group, and found new measures helped improve patient recovery and reduce the length of time they had to stay in hospital.

“Through the introduction of ERAS, our patients now expect to arrive on the morning of their surgery and be out of bed, standing and walking that evening,” explains Associate Professor Gwynne-Jones. “While ERAS principals are well-established, our trial showed that it was effective even in when implemented across the service – not just among a select group of patients - and for hospital patients with high average BMI or who have very severe osteoarthritis and multiple co-morbidities.”

The introduction of ERAS was part of a new Orthopaedic Patient Pathway. In addition to day-of-surgery mobilisation, changes to procedures included new pre-admission education sessions, improved management of perioperative anaemia, standardised anaesthetic guidelines, and improved discharge planning. Following the introduction of the programme average length of stay fell from 5.6 days to 4.3 days for hip replacement patients and from 5.7 to 4.8 days for knee replacement patients. Unlike some overseas studies, there was limited use of step-down or rehabilitation beds, with 98% of patients discharged home.

Professor Gwynne-Jones said the multidisciplinary approach, team work and openness to change have been essential to the programme’s success. “These results could not have been achieved without the commitment and support of our medical, nursing, and allied health staff. Communication and data analysis was crucial to feedback how well we were doing. It is important to keep the momentum going as we continue ERAS in orthopaedics, and try to add to the gains already made.”