ERAS Program Changes Enabled Outpatient Joint Replacement During the Pandemic

Adaptations to an Enhanced Recovery After Surgery (ERAS) program for total hip and total knee arthroplasty patients were so successful during the COVID-19 pandemic that they have been implemented permanently at the institution, according to a quality improvement study being presented at the ANESTHESIOLOGY 2022 annual meeting.

In 2019, Stony Brook Medicine in New York implemented an ERAS program for elective hip and knee arthroplasty, with all patients spending at least 1 night in the hospital after the procedure. However, during the pandemic the team revised the ERAS program so that select patients could have an outpatient procedure.

The new ERAS protocol included:

  • Developing a highly selective screening process to identify patients who would be good candidates for same-day surgery (ie, relatively healthy, highly motivated, with a good home-support system)
  • Using a shorter-acting spinal anesthetic
  • Hydrating patients before the procedure and restricting the fluids used during surgery
  • Minimizing the use of urinary catheters to prevent infection
  • Improving pain management by sending patients home on a non-opioid pain pump
  • Providing home follow-up, including visits by nurses and physical therapists

“We found for many patients, same-day surgeries are a safe alternative to an extended hospital stay,” said Sunitha Singh, MD, lead author of the quality improvement project and coordinator for the ERAS program at Stony Brook Medicine.

“Education, prehabilitation, and patient engagement are critical to the recovery process. Patients often feel more rested recovering at home in familiar surroundings, and we have made the ERAS changes permanent due to the high success.”

Elective surgeries at Stony Brook Medicine were stopped during the peak of the pandemic (April 2020 to May 2020). The hospital implemented the new ERAS protocol beginning in June 2020 to provide continuity of care.

Over a 1-year period, 152 patients had knee or hip arthroplasty under the new program. Compared with patients who had the traditional ERAS protocol, patients in the new ERAS program stayed in the hospital an average of 8 hours versus an average of 1.7 days. No readmissions were reported.

Currently, about 40% of the hospital’s hip and knee arthroplasty patients participate in the same-day surgery ERAS program.

“Our findings demonstrate the adaptability of our health care system — including leveraging ERAS programs to respond to health care emergencies — while improving the quality of care,” Dr. Singh said.

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