• Javier Ripollés-Melchor, Ane Abad-Motos, Yolanda Díez-Remesal, Marta Aseguinolaza-Pagola, Lidia Padin-Barreiro, Rubén Sánchez-Martín, Margarita Logroño-Egea, Juan C Catalá-Bauset, Silvia García-Orallo, Elvira Bisbe, Nuria Martín, Alejandro Suárez-de-la-Rica, Ana B Cuéllar-Martínez, Silvia Gil-Trujillo, Juan Carlos Estupiñán-Jiménez, Marta Villanova-Baraza, Cristina Gil-Lapetra, Pilar Pérez-Sánchez, Nicolás Rodríguez-García, Alvaro Ramiro-Ruiz, Carla Farré-Tebar, Alejandro Martínez-García, Pedro Arauzo-Pérez, Cristina García-Pérez, Alfredo Abad-Gurumeta, María A Miñambres-Villar, Alberto Sánchez-Campos, Ignacio Jiménez-López, José M Tena-Guerrero, Oliver Marín-Peña, Míriam Sánchez-Merchante, Ubaldo Vicente-Gutiérrez, María C Cassinello-Ogea, Carlos Ferrando-Ortolá, Héctor Berges-Gutiérrez, Jesús Fernanz-Antón, Manuel A Gómez-Ríos, Daniel Bordonaba-Bosque, José M Ramírez-Rodríguez, José Antonio García-Erce, César Aldecoa, and Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM).
• Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.
• JAMA Surg. 2020 Apr 1; 155 (4): e196024.

ImportanceThe Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.ObjectiveTo assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).Design, Setting, And ParticipantsThis multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019.ExposuresTotal hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not.Main Outcomes And MeasuresThe primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality.ResultsDuring the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001).Conclusions And RelevanceAn increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.

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