Implementation of an institutional Enhanced Recovery After Surgery (ERAS) pathway is associated with fewer in-hospital falls after total knee arthroplasty.

Abstract

To evaluate whether implementation of an Enhanced Recovery After Surgery (ERAS)-based perioperative pathway was associated with a lower rate of postoperative in-hospital falls after total knee arthroplasty (TKA). This retrospective single-centre before-after study included 314 patients undergoing primary TKA (151 treated before and 163 treated after implementation of an ERAS-based pathway). The documented pathway components included local infiltration analgesia, tranexamic acid, omission of surgical drains and continuous femoral nerve analgesia and physiotherapist-assisted active and passive mobilization on the day of surgery. The primary outcome was an in-hospital fall documented through the institutional incident-reporting system. Secondary outcomes included pain, opioid consumption, range of motion and postoperative complications. In-hospital falls occurred in 1 of 163 patients in the ERAS group (0.6%) and 10 of 151 patients in the non-ERAS group (6.6%) (risk ratio, 0.09; 95% confidence interval [CI], 0.01-0.72; <i>p</i> = 0.004), corresponding to an absolute risk reduction of 6.0 percentage points (95% CI, 1.9-11.2 percentage points). Three falls required medical treatment. Pain at rest was comparable, whereas opioid consumption was lower in the ERAS group (<i>p</i> < 0.001). Time to achieve 90° of knee flexion was shorter in the ERAS group (<i>p</i> < 0.001). Postoperative complications occurred in 0 of 163 ERAS patients and 5 of 151 non-ERAS patients (0% vs. 3.3%; <i>p</i> = 0.025). Implementation of an ERAS-based perioperative pathway was associated with fewer postoperative in-hospital falls after primary TKA. Because the pathway was introduced as a bundle in a retrospective before-after study, causality cannot be established. Level III, retrospective cohort study.