Rapid Recovery in Hip and Knee Replacement Surgery (ERAS)
ERAS (Enhanced Recovery After Surgery )
When I started in Yeovil as a consultant 15 years ago, the average length of stay for patients undergoing hip or knee replacement surgery was between 8 and 9 days. This was common in all hospitals.
Enhanced Recovery After Surgery (ERAS) had recently been pioneered in patients undergoing major bowel surgery, enabling a faster recovery and a quicker return to normal life. This programme utilised multidisciplinary team working (including surgeons, anaesthetists, therapists and specialist nurses) in order for this approach to be successful. Yeovil was at the forefront of this approach in the UK.
I looked at its application in Orthopaedics and gathered a dedicated team together in the hospital, then set about developing a programme applicable to patients who were receiving hip or knee replacements.
Over the years this approach has been refined and improved with significant benefits to both the patient and the health service. Patient education is a key factor in reducing length of stay. When you are seen in the outpatient clinic you will be given a comprehensive booklet about your surgery, what to expect, and how best you can prepare for this.
You will subsequently be seen in the Pre-op assessment Clinic – to assess your general health and fitness for surgery (blood tests, heart and lung checks, etc). You will also have an appointment with the anaesthetist to discuss your anaesthetic options prior to admission for surgery. Pre-operative screening ensures patient health is optimised before surgery proceeds thus maximising the benefits of surgery and reducing the risks.
We encourage patients to mobilise very quickly after surgery and the time spent in bed is minimised. This helps reduce potential risks such as deep vein thrombosis (blood clots), chest and urinary infections, and stimulates early return of muscle function.
Now patients on average stay only 2 or 3 nights in hospital, and this continues to reduce with same-day discharge home after hip or knee replacement now possible in selected patients. The days when patients came in to hospital with a suitcase full of belongings for a protracted stay are a thing of the past.