Enhanced recovery after surgery: the future of elective arthroplasty?

Abstract

Summary:

Enhanced recovery after surgery is a method of streamlining the patient journey pre-, intra- and post-operatively in order to account for foreseeable and unforeseeable barriers to recovery. Originally pioneered in general surgery, the technique has been adopted in other specialities, given its potential to minimise the duration of hospitalisation, hasten recovery and improve patient experience. Enhanced recovery programmes are of particular interest in orthopaedic surgery, where patients who often have multiple comorbidities could gain substantial benefits from more efficient management. This is particularly pertinent given the rising prevalence of age-related joint disease requiring arthroplasty: Enhanced Recovery is more economically and clinically efficient.

Relevance:

Enhanced recovery is a relatively novel - heterogeneously implemented – method of managing the surgical patient journey. Intrinsic to the success of such programmes is a thorough understanding of its components and close communication within the multidisciplinary team. Medical students’ understanding of what these protocols involve will significantly affect their management of foreseeable – and unforeseeable – barriers to success in elective surgical patients during clinical years and in their future practice. It is therefore essential that all medical students – whether they have an interest in a surgical career or not – have a grounding in the components of enhanced recovery, because such programmes will form part of their practice at some point in their careers.

Take-home message:

Enhanced recovery is a proactive intervention, which has been shown to be extremely effective across a number of surgical disciplines in reducing length of stay, whilst maximising postoperative outcomes. Trainees would benefit from a detailed knowledge of enhanced recovery programmes in order to provide a higher standard of care during their encounters with patients at every stage of the surgical pathway.