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

Kyle Matuszewki, RN, DNP, CRNA

DNP Nurse Anesthesia 

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

Project Category: Original Research

Project Team: Kyle Matuszewki, DNP, CRNA,Mia Burgos, DNP, CNRA, Terence Fon, DNP, CRNA, Michael Ledvina, DNAP, CRNA, APNP, Jennifer 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 Slide Presentation Video