The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis

Aims: The aim of this study is to assess the impact of a pilot enhanced recovery after surgery (ERAS) programme on length of stay (LOS) and post-discharge resource usage via service evaluation and cost analysis. Methods: Between May and December 2019, 100 patients requiring hip or knee arthroplasty...

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Autores principales:	David J. Milligan, Janet C. Hill, Ashley Agus, Leeann Bryce, Nicola Gallagher, David Beverland
Formato:	article
Lenguaje:	EN
Publicado:	The British Editorial Society of Bone & Joint Surgery 2021
Materias:	arthroplasty hip knee enhanced recovery outcomes service evaluation quality improvement length of stay rehabilitation hip and knee arthroplasty anesthesiologists primary joint arthroplasty joint arthroplasty physiotherapist covid-19 statistical analysis Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/cd6254d19b2d45feb2e2b29405530832
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spelling	oai:doaj.org-article:cd6254d19b2d45feb2e2b294055308322021-12-01T18:44:47ZThe impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis2633-146210.1302/2633-1462.211.BJO-2021-0125.R1https://doaj.org/article/cd6254d19b2d45feb2e2b294055308322021-11-01T00:00:00Zhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0125.R1https://doaj.org/toc/2633-1462Aims: The aim of this study is to assess the impact of a pilot enhanced recovery after surgery (ERAS) programme on length of stay (LOS) and post-discharge resource usage via service evaluation and cost analysis. Methods: Between May and December 2019, 100 patients requiring hip or knee arthroplasty were enrolled with the intention that each would have a preadmission discharge plan, a preoperative education class with nominated helper, a day of surgery admission and mobilization, a day one discharge, and access to a 24/7 dedicated helpline. Each was matched with a patient under the pre-existing pathway from the previous year. Results: Mean LOS for ERAS patients was 1.59 days (95% confidence interval (CI) 1.14 to 2.04), significantly less than that of the matched cohort (3.01 days; 95% CI 2.56 to 3.46). There were no significant differences in readmission rates for ERAS patients at both 30 and 90 days (six vs four readmissions at 30 days, and nine vs four at 90 days). Despite matching, there were significantly more American Society of Anesthesiologists (ASA) grade 3 patients in the ERAS cohort. There was a mean cost saving of £757.26 (95% CI £-1,200.96 to £-313.56) per patient. This is despite small increases in postoperative resource usage in the ERAS patients. Conclusion: ERAS represents a safe and effective means of reducing LOS in primary joint arthroplasty patients. Implementation of ERAS principles has potential financial savings and could increase patient throughput without compromising care. In elective care, a preadmission discharge plan is key. Cite this article: Bone Jt Open 2021;2(11):966–973.David J. MilliganJanet C. HillAshley AgusLeeann BryceNicola GallagherDavid BeverlandThe British Editorial Society of Bone & Joint Surgeryarticlearthroplastyhipkneeenhanced recoveryoutcomesservice evaluationquality improvementlength of stayrehabilitationhip and knee arthroplastyanesthesiologistshiphip and knee arthroplastyprimary joint arthroplastyjoint arthroplastykneephysiotherapistcovid-19statistical analysisOrthopedic surgeryRD701-811ENBone & Joint Open, Vol 2, Iss 11, Pp 966-973 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	arthroplasty hip knee enhanced recovery outcomes service evaluation quality improvement length of stay rehabilitation hip and knee arthroplasty anesthesiologists hip hip and knee arthroplasty primary joint arthroplasty joint arthroplasty knee physiotherapist covid-19 statistical analysis Orthopedic surgery RD701-811
spellingShingle	arthroplasty hip knee enhanced recovery outcomes service evaluation quality improvement length of stay rehabilitation hip and knee arthroplasty anesthesiologists hip hip and knee arthroplasty primary joint arthroplasty joint arthroplasty knee physiotherapist covid-19 statistical analysis Orthopedic surgery RD701-811 David J. Milligan Janet C. Hill Ashley Agus Leeann Bryce Nicola Gallagher David Beverland The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
description	Aims: The aim of this study is to assess the impact of a pilot enhanced recovery after surgery (ERAS) programme on length of stay (LOS) and post-discharge resource usage via service evaluation and cost analysis. Methods: Between May and December 2019, 100 patients requiring hip or knee arthroplasty were enrolled with the intention that each would have a preadmission discharge plan, a preoperative education class with nominated helper, a day of surgery admission and mobilization, a day one discharge, and access to a 24/7 dedicated helpline. Each was matched with a patient under the pre-existing pathway from the previous year. Results: Mean LOS for ERAS patients was 1.59 days (95% confidence interval (CI) 1.14 to 2.04), significantly less than that of the matched cohort (3.01 days; 95% CI 2.56 to 3.46). There were no significant differences in readmission rates for ERAS patients at both 30 and 90 days (six vs four readmissions at 30 days, and nine vs four at 90 days). Despite matching, there were significantly more American Society of Anesthesiologists (ASA) grade 3 patients in the ERAS cohort. There was a mean cost saving of £757.26 (95% CI £-1,200.96 to £-313.56) per patient. This is despite small increases in postoperative resource usage in the ERAS patients. Conclusion: ERAS represents a safe and effective means of reducing LOS in primary joint arthroplasty patients. Implementation of ERAS principles has potential financial savings and could increase patient throughput without compromising care. In elective care, a preadmission discharge plan is key. Cite this article: Bone Jt Open 2021;2(11):966–973.
format	article
author	David J. Milligan Janet C. Hill Ashley Agus Leeann Bryce Nicola Gallagher David Beverland
author_facet	David J. Milligan Janet C. Hill Ashley Agus Leeann Bryce Nicola Gallagher David Beverland
author_sort	David J. Milligan
title	The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
title_short	The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
title_full	The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
title_fullStr	The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
title_full_unstemmed	The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
title_sort	impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis
publisher	The British Editorial Society of Bone & Joint Surgery
publishDate	2021
url	https://doaj.org/article/cd6254d19b2d45feb2e2b29405530832
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The impact of an enhanced recovery programme on length of stay and post-discharge resource usage following hip and knee arthroplasty: a service evaluation and cost analysis

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