Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

Garriga C et al. Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”. Osteoarthritis Cartilage. 2019 Sep;27(9):1280-1293. 

What is already known:

ERAS pathways have consistently shown improvements in outcomes in a wide variety of specialities. However the majority of these studies have been small single centre ones. There are few national studies, a notable exception being Denmark, and this is one of the first looking at NHS data in England, Wales, Northern Ireland and the Isle of Man.

What this paper adds:

This was a national study looking at Total Knee Replacements, using the National Joint Registry and Hospital Episode Statistics. They compared three time periods, pre-intervention (2008-9), during (2009-2011) and post (2012-2016). Almost 500,000 patients were included. Overall length of stay reduced from 5.8 to 3.7 days. Bed-day costs also improved from £7607 to £5276. Complications were also reduced from 4.1% to 1.7%, and PROMS data also were improved (Oxford Knee Score). Some might argue that these data were on a gradual decline anyway and ERAS didn’t have a big impact on these improvements. This study does not confirm whether there was widespread adoption on ERAS in all centres, and so it is difficult draw complete conclusions as to the national effect of ERAS implementation.

Chris Jones, Guildford.