LAUSR

Enhanced recovery after surgery (ERAS) programs represent a multidisciplinary approach to improving patient care by shortening hospital length of stay (LOS), reducing complications and morbidity, and improving overall patient satisfaction and experience. Although much of the early work on ERAS was carried out in abdominal and colorectal surgical populations, similar programs have been well established for orthopedic patients in recent years, particularly those undergoing total joint replacement. These have been shown to reduce LOS and readmission rates, reduce hospital costs, and improve early functional recovery. One observational study of 4500 primary hip and knee patients observed a significant reduction in 30and 90-day mortality when an ERAS program was introduced. Total joint arthroplasty (TJA) is particularly well suited to the ERAS philosophy because of its very nature: the indication for TJA is pain, and the surgical procedures are designed to improve functional recovery with little impact on other body systems. As such, the goals of the ERAS program are aligned with the primary goal of the operation. Despite this, outcomes can and do vary greatly depending on specific patient, anesthetic, and surgical factors, and opportunities to streamline care pathways for orthopedic patients continue to exist. The aim of this article is to highlight the common interventions that may be used in orthopedic ERAS programs and to discuss the supporting evidence. Interventions have been grouped into those carried out in the preoperative, intraoperative, and postoperative phases of care. The focus is primarily on elective TJA, as the majority of this work has been carried out in this population.