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Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis
  1. Qi-Feng Deng1,
  2. Hui-Yun Gu2,
  3. Wu-ya Peng3,
  4. Qiong Zhang3,
  5. Zheng-Dong Huang1,
  6. Chao Zhang1,
  7. Yun-Xiang Yu3
  1. 1 Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
  2. 2 Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
  3. 3 Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
  1. Correspondence to Professor Chao Zhang, Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China; zhangchao0803{at}; Dr Yun-Xiang Yu, Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China; yuyunxiangtaihe{at}


Study design Systematic review with meta-analysis.

Objectives To evaluate the effects of enhanced recovery after surgery (ERAS) on the postoperative recovery of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods The PubMed, Embase, Cochrane and ISI Web of Science databases were searched to identify literature including randomised controlled trials (RCTs), cohort studies and case–control studies through 2 May 2018. The analysed outcomes were mortality rate, transfusion rate, range of motion (ROM), 30-day readmission rate, postoperative complication rate and in-hospital length of stay (LOS).

Results A total of 25 studies involving 16 699 patients met the inclusion criteria and were included in the meta-analysis. Compared with conventional care, ERAS was associated with a significant decrease in mortality rate (relative risk (RR) 0.48, 95% CI 0.27 to 0.85), transfusion rate (RR 0.43, 95% CI 0.37 to 0.51), complication rate (RR 0.74, 95% CI 0.62 to 0.87) and LOS (mean difference (MD) −2.03, 95% CI −2.64 to −1.42) among all included trials. However, no significant difference was found in ROM (MD 7.53, 95% CI −2.16 to 17.23) and 30-day readmission rate (RR 0.86, 95% CI 0.56 to 1.30). There was no significant difference in complications of TKA (RR 0.84, 95% CI 0.34 to 2.06) and transfusion rate in RCTs (RR 0.66, 95% CI 0.15 to 2.88) between the ERAS group and the control group.

Conclusions This meta-analysis showed that ERAS significantly reduced the mortality rate, transfusion rate, incidence of complications and LOS of patients undergoing TKA or THA. However, ERAS did not show a significant impact on ROM and 30-day readmission rate. Complications after hip replacement are less than those of knee replacement, and the young patients recover better.

Level of evidence Level 1.

  • orthopedic procedures
  • fast-track surgery
  • joint replacement
  • knee arthroplasty
  • range of motion
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  • Q-FD and H-YG are joint first authors.

  • Contributors CZ and Y-XY had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Q-FD and CZ designed the study. Q-FD and Z-DH developed and tested the data collection forms. H-YG, W-YP and QZ acquired the data. Q-FD, H-YG and Z-DH conducted the analysis and interpreted the data. Q-FD drafted the manuscript. All authors critically revised the manuscript. CZ and Y-XY are guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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