In the recent past, hip or knee replacement surgery required a lengthy hospital stay for recuperation. That was typically followed by rehabilitation in a skilled nursing facility.
In 1990 the average length of a hospital stay was 10 days; by 2000, it had declined to five. Today, patients often are discharged from the hospital to home the same day as surgery or the following day. These changes all result from advances in caring for patients before, during, and after surgery.
Preparing surgery patients for quicker recovery
Enhanced recovery after surgery (ERAS) is a highly effective approach to helping patients prepare for surgery and recover quickly. The ERAS program focuses on making patients as healthy as possible before surgery. Also, advances in surgical technique combined with new approaches to anesthesia and pain relief also allow patients to get back on their feet quickly after the operation. Think of it as advanced “prehab” in addition to rehab.
The ERAS approach for joint replacement patients
The ERAS approach is about optimizing your physical and mental health before admission. The aim is to diminish the impact of surgery on the body, to minimize stress and to treat pain proactively.
With the ERAS program, most patients return to the normal activities of daily living much faster and with much less pain.
The Benefits of ERAS
The ERAS protocol was first developed in Europe in 2001 and has been adopted in more than 20 countries. It was first used with colorectal surgery cases but is now used in a broad range of surgical fields, where it’s been shown to improve patient outcomes.
Using this approach, a majority of all joint replacement procedures could soon be done on an outpatient basis. Its many benefits for patients include:
- shorter hospital stays
- quicker recovery
- reduced incidence of complications
- fewer readmissions
- lower costs
The ERAS Steps
- Education: The ERAS approach starts with thorough education of the patient, family and support team. It is important that all involved understand the surgery and know what to expect.
- “Prehab” Physical Therapy: Weeks before the surgery, a physical therapist assesses the patient and teaches muscle-strengthening and flexibility exercises, not only for the involved joint but also generally for the arms and legs. The therapist might even recommend cardiac or pulmonary rehabilitation to further build endurance.
- Practice with Crutches: As part of prehab, patients are also taught how to walk with European “cuff” crutches. Unlike traditional crutches, these lightweight devices offer patients the ability to be assisted while walking with a more natural gait. Patients are encouraged to practice walking around their home with crutches, so that they feel comfortable and confident after surgery.
- Proactive Pain Control: Another important part of the ERAS program is proactive pain control. Typically starting three days before surgery, we prescribe three non-opioid medications. These prescriptions work together in advance of your surgery to reduce inflammation, slow transmission of pain signals through the nerves, and treat the pain itself. These same medications are used post-operatively, greatly limiting the need for opioids.
- No Fasting Required: Because we use regional instead of general anesthesia, there’s no need for you to fast. We give our patients a clear complex carbohydrate drink the night before surgery as well as the next morning. Patients are still not allowed solid food after midnight but can have clear liquids up to two hours before their procedure. As a result, our patients do not feel weak, hungry or dehydrated at surgery time.
- After Surgery: Within hours of their surgery patients are returned to a normal diet, get dressed in their own comfortable clothing and then get up and move around with a therapist or nurse.
- Physical Therapy: Ideally, patients are able to do physical therapy twice the day of surgery and once the next morning. At this point they can be safely discharged home to continue their recovery.
- Recovery: Patients can fully bear weight on the operative leg and are only on crutches for one to two weeks. This compares to four to six weeks in the past.
For more information on joint replacement and how we can help you, visit the Lifespan Orthopedics Institute website.
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