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The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units—an implementation and follow-up at 1 year, 2010–2011: a report from the Musculoskeletal Audit, Scotland

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

To establish whether a nationally guided programme can lead to more widespread implementation of enhanced recovery after surgery (ERAS), a well-established optimised care pathway for lower limb arthroplasty.

Design

In 2010, National Services Scotland’s Musculoskeletal Audit was asked to perform a ‘snapshot’ audit of the current peri-operative management of patients undergoing total hip and knee arthroplasty in all 22 Scottish orthopaedic units with an identical follow-up audit in 2011 after input and support from the national steering group.

Population

Audit 1 and audit 2 involved 1,345 and 1,278 patients, respectively.

Results

The number of Scottish units that developed an ERAS programme increased from 8 (36 %) to 15 (68 %). Units that included more ERAS patients had earlier mobilisation rates (146/474, 36 % ERAS patients mobilised same day vs. 34/873, 4 % non-ERAS; n = 22 units, r = 0.55, p = 0.008) and shorter post-operative length of stay (median 4 days vs. ERAS, 5 days non-ERAS, n = 22 units, r = −0.64, p = 0.001). ERAS knee arthroplasty patients had lower blood transfusion rates (5/205, 2 % vs. 51/399, 13 %, n = 22 units, r = −0.62, p = 0.002). Units that restricted the use of IV fluids post-operatively had higher early mobilisation rates (n = 22 units, r = 0.48, p = 0.03) and shorter post-operative length of stay (n = 22 units, r = −0.56, p = 0.007). Reduced use of patient-controlled analgesia was also associated with earlier mobilisation (n = 22 units, r = 0.49, p = 0.02) and shorter length of stay (n = 22 units, r = −0.39, p = 0.07). Urinary catheterisation rates also dropped from 468/1,345 (35 %) in 2010 to 337/1,278 (26 %) in 2011 (n = 22 units, z = 2.19, p = 0.03).

Conclusion

A clinically guided and nationally supported process has proven highly successful in achieving a further uptake of enhanced recovery principles after lower limb arthroplasty in Scotland, which has resulted in clinical benefits to patients and reduced length of hospital stay.

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Conflict of interest

None of the authors is aware of any competing interests. We wish to declare no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

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Authors and Affiliations

  1. Departments of Anaesthesia and Rehabilitation, Golden Jubilee National Hospital, Clydebank, G81 4HX, UK

    Nicholas B. Scott & David McDonald

  2. Musculoskeletal (MSk) Audit, Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9 EB, UK

    Jane Campbell & Richard D. Smith

  3. Departments of Orthopaedic Surgery and Anaesthesia, Edinburgh Royal Infirmary, Little France, Old Dalkeith Road, Edinburgh, EH16 4SU, UK

    A. Kate Carey & Steffen J. Breusch

  4. Department of Anaesthesia, Raigmore Hospital, Old Perth Road, Inverness, Inverness-shire, IV2 3UJ, UK

    Ian G. Johnston

  5. The Scottish Executive, St Andrew’s House, Regent Road, Edinburgh, EH1 3DG, UK

    Kate R. James

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  1. Nicholas B. Scott
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  3. Jane Campbell
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Correspondence to Nicholas B. Scott.

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Scott, N.B., McDonald, D., Campbell, J. et al. The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units—an implementation and follow-up at 1 year, 2010–2011: a report from the Musculoskeletal Audit, Scotland. Arch Orthop Trauma Surg 133, 117–124 (2013). https://doi.org/10.1007/s00402-012-1619-z

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  • DOI: https://doi.org/10.1007/s00402-012-1619-z

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