Terence Fon, RN, DNP, CRNA

DNP Nurse Anesthesia 

Evaluating Enhanced Recovery After Surgery (ERAS) for Total Knee Arthroplasty (TKA)

Project Category: Original Research

Project Team: Terence Fon, DNP, CRNA, Kyle Matuszewki, DNP, CRNA, Mia Burgos, DNP, CNRA, Michael Ledvina, DNAP, CRNA, APNPJennifer Greenwood, DNP, PhD, Brooke Williams, DNP, CRNA, APNP (Advisor)

Abstract

Background: Enhanced Recovery After Surgery (ERAS) includes early mobilization, multimodal pain management, and reduced opioid use. In 2019, a midwestern community hospital implemented an ERAS protocol for total knee arthroplasty (TKA) patients; however, no study has been done to evaluate outcomes related to this protocol adaptation. 

Methods: Retrospective data collection was utilized to compare a pre- and post-ERAS group of patients following TKA. Out of 662 subjects, a random sample of 90 patients were selected from a pre-ERAS group (n = 30), a post-ERAS-A group from surgeon-A (n = 30), and a post-ERAS-B group from surgeon-B (n = 30). Data was manually extracted by the investigators from the electronic medical record to reduce export error. Data regarding patient characteristics and outcomes were compared using multiple statistical approaches.

Results: Patients receiving the ERAS protocol showed a significant reduction in length of stay from 3.33 ±1.73 days in the pre-ERAS group to 1.93 ±1.70 (post-ERAS-A), and 2.30 ±1.39 (post-ERAS-B), p = 0.003. There was a significant decrease in 24-hour post-op pain scores between the pre-ERAS and post-ERAS-A groups: 5.80 ±2.31 versus 3.73 ±3.06, p = 0.016; and opioid use between pre-ERAS and post-ERAS-A groups: 23.68 ±21.25 versus 11.62 ±11.30, p = 0.029. There was no significant difference in time to mobility in hours between groups.

Conclusion: Adopting ERAS protocols can be associated with improved patient outcomes and should be considered for implementation at other hospitals.

Full Manuscript