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J Knee Surg 2022; 35(04): 424-433
DOI: 10.1055/s-0040-1715125
Original Article

Enhanced Recovery after Surgery for Knee Arthroplasty in the Era of COVID-19

Benjamin Tze Keong Ding 
1   Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
,
Jensen Ng 
2   Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
,
Kelvin Guoping Tan 
1   Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
› Author Affiliations Funding None.
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Abstract

Enhanced recovery after surgery (ERAS) represents a paradigm shift in perioperative care, aimed at achieving early recovery for surgical patients, reducing length of hospital stay, and complications. The purpose of this study was to provide an insight of the impact of the COVID-19 on ERAS protocols for knee arthroplasty patients in a tertiary hospital and potential strategy changes for postpandemic practice. We retrospectively reviewed all cases that underwent surgery utilizing ERAS protocols in the quarter prior to the pandemic (fourth quarter of 2019) and during the first quarter of 2020 when the pandemic started. A review of the literature on ERAS protocols for knee arthroplasty during the COVID-19 pandemic was also performed and discussed. A total of 199 knee arthroplasties were performed in fourth quarter of 2019 as compared with 76 in the first quarter of 2020 during the COVID-19 outbreak. Patients who underwent surgery in the first quarter of 2020 had shorter inpatient stays (3.8 vs. 4.5 days), larger percentage of discharges by postoperative day 5 (86.8 vs. 74.9%), and a larger proportion of patients discharged to their own homes (68 vs. 54%). The overall complication rate (1.3 vs. 3%) and readmission within 30 days (2.6 vs. 2%) was similar between both groups. ERAS protocols appear to reduce hospital lengths of stay for patients undergoing knee arthroplasty without increasing the risk of short-term complications and readmissions. The beneficial effects of ERAS appear to be amplified by and are synchronous with the requirements of operating in the era of a pandemic.

Keywords

COVID-19 - pandemic - Singapore - coronavirus - enhanced recovery after surgery - knee arthroplasty

Ethical Approval

The study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. The study has been performed in accordance with relevant regulations of the U.S. Health Insurance Portability and Accountability Act. Details that might disclose the identity of the subjects under study have been omitted.


Note

The investigation was performed at the Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.




Publication History

Received: 05 June 2020

Accepted: 25 June 2020

Article published online:
24 August 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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