Enhanced Recovery After Surgery program enables same-day hip and knee replacement surgeries during pandemic

Adaptations to a program that helps ensure the best possible outcomes from surgery allowed eligible patients to receive their hip and knee replacement surgeries during the COVID-19 pandemic without spending the night in the hospital. The changes were so successful that they have been implemented permanently at the institution, according to a quality improvement study being presented at the Anesthesiology 2022 annual meeting.

Championed by physician anesthesiologists, Enhanced Recovery After Surgery (ERAS) programs ease the effects of surgery and fast-track patient recovery.

In 2019, Stony Brook Medicine in New York implemented an ERAS program for elective hip and knee replacement surgeries, with all patients spending at least one night in the hospital after the procedure. However, during the pandemic the team revised the ERAS program so that selective patients could have an outpatient procedure, meaning they didn't spend the night in the hospital.

The new ERAS protocol included:

• Developing a highly selective screening process to identify patients who would be good candidates for same-day surgery (i.e., 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, M.D., 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-May 2020). The hospital implemented the new ERAS protocol beginning in June 2020 to provide continuity of care.

Over a one-year period, 152 patients had knee or hip replacement under the new program. Compared to patients who had the traditional ERAS protocol, patients in the new ERAS program stayed in the hospital an average of eight hours vs. an average of 1.7 days. No readmissions were reported. Currently, about 40% of the hospital's hip and knee replacement 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.