A new meta-analysis of 15 published studies from researchers at the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China, have tackled the issue of enhanced recovery after surgery.
Enhanced Recovery May Reduce Postop Complications and More
1 min read Premium comments
Secondary#enhancedrecoveryaftersurgery#postoperativerecovery
Their work, “An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis,” appears in the March 13, 2019 edition of the Journal of Orthopaedic Surgery and Research.
Co-author Ai-Min Wu, M.D., Ph.D., with the Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University explained the genesis of the study to OTW, “In recent years, the concept of enhanced recovery after surgery has reached a consensus in a number of surgical fields and is well established. And it turns out to be credible that the enhance recovery after surgery can make sense in postoperative recovery, which is also a critical part in orthopedics. But there are still few reports and systematic studies on enhanced recovery or fast-track surgery in the specific area of orthopedics.”
Enhanced Recovery After Surgery refers to, according to the American Association of Nurse Anesthetists, “…a patient-centered, evidence-based, multidisciplinary team developed pathways for a surgical specialty and facility culture to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery. These care pathways form an integrated continuum, as the patient moves from home through the pre-hospital/preadmission, preoperative, intraoperative, and postoperative phases of surgery and home again.”
The researchers searched PubMed, EMBASE, and Cochrane databases from their inception to May 31, 2018.
Dr. Wu summarized some of the findings to OTW, “Our meta-analysis suggested that enhanced recovery patients had more advantages in reducing the incidence of postoperative complications, 30-day mortality rate and ODI [Oswestry Disability Index] after orthopedic surgery, but not of 30-day readmission rate in orthopedic surgery. However, further research with standardized, unbiased methods and larger sample sizes is required for deeper analysis.”
“An enhanced recovery after surgery program in orthopedic surgery will provide great benefit to the patients under surgeries. We recommend the its routine in orthopedic surgery.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.