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Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man"

Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man"
Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man"
Objective

We aimed to test whether a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) had an impact on patient outcomes.
Design

Natural-experiment (April 2008–December 2016). Interrupted time-series regression assessed impact on trends before-during-after ERAS implementation.
Setting

Primary operations from the UK National Joint Registry (NJR) were linked with Hospital Episode Statistics (HES) data which contains inpatient episodes undertaken in National Health Service (NHS) trusts in England, and Patient Reported Outcome Measures (PROMs).
Participants

Patients undergoing primary planned TKR aged ≥18 years.
Intervention

ERAS implementation (April 2009–March 2011).
Outcomes

Regression coefficients of monthly means of Length of stay (LOS), bed day costs, change in Oxford knee scores (OKS) 6-months after surgery, complications (at 6 months), and rates of revision surgeries (at 5 years).
Results

486,579 primary TKRs were identified. Overall LOS and bed-day costs decreased from 5.8 days to 3.7 and from £7607 to £5276, from April 2008 to December 2016. Oxford knee score (OKS) change improved from 15.1 points in April 2008 to 17.1 points in December 2016. Complications decreased from 4.1 % in April 2008 to 1.7 % in March 2016. 5-year revision rates remained stable at 4.8 per 1000 implants years in April 2008 and December 2011. After ERAS, declining trends in LOS and bed costs slowed down; OKS improved, complications remained stable, and revisions slightly increased.
Conclusions

Different secular trends in outcomes for patients having TKR have been observed over the last decade. Although patient outcomes are better than a decade ago ERAS did not improve them at national level.
1063-4584
Garriga, C.
5403565c-65fd-448f-904f-e41df634c888
Murphy, J.
fdfe8f69-8733-4cdb-8e71-f55c062aed20
Leal, J.
dc621c35-59cb-49d2-ab7a-0ada841eb3b7
Price, A.
0544e71a-16ce-48b4-afb2-4ef3e448cbc5
Prieto-Alhambra, D.
e596722a-2f01-4201-bd9d-be3e180e76a9
Carr, A.
6a3dea28-d7bd-41ba-b140-367f3abc4215
Arden, N.
23af958d-835c-4d79-be54-4bbe4c68077f
Rangan, A.
43851a67-c33a-4b60-9496-f55cc24bbdf9
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Peat, G.
eb84fa13-dcd6-4891-9215-607717dbc2fb
Fitzpatrick, R.
bea5c739-8a31-41ad-995b-c91919bb4211
Barker, K.
d62faa30-1433-427a-af29-7e41b079de49
Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d
Garriga, C.
5403565c-65fd-448f-904f-e41df634c888
Murphy, J.
fdfe8f69-8733-4cdb-8e71-f55c062aed20
Leal, J.
dc621c35-59cb-49d2-ab7a-0ada841eb3b7
Price, A.
0544e71a-16ce-48b4-afb2-4ef3e448cbc5
Prieto-Alhambra, D.
e596722a-2f01-4201-bd9d-be3e180e76a9
Carr, A.
6a3dea28-d7bd-41ba-b140-367f3abc4215
Arden, N.
23af958d-835c-4d79-be54-4bbe4c68077f
Rangan, A.
43851a67-c33a-4b60-9496-f55cc24bbdf9
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Peat, G.
eb84fa13-dcd6-4891-9215-607717dbc2fb
Fitzpatrick, R.
bea5c739-8a31-41ad-995b-c91919bb4211
Barker, K.
d62faa30-1433-427a-af29-7e41b079de49
Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d

Garriga, C., Murphy, J., Leal, J., Price, A., Prieto-Alhambra, D., Carr, A., Arden, N., Rangan, A., Cooper, C., Peat, G., Fitzpatrick, R., Barker, K. and Judge, A. (2019) Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man". Osteoarthritis and Cartilage. (doi:10.1016/j.joca.2019.05.001).

Record type: Article

Abstract

Objective

We aimed to test whether a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) had an impact on patient outcomes.
Design

Natural-experiment (April 2008–December 2016). Interrupted time-series regression assessed impact on trends before-during-after ERAS implementation.
Setting

Primary operations from the UK National Joint Registry (NJR) were linked with Hospital Episode Statistics (HES) data which contains inpatient episodes undertaken in National Health Service (NHS) trusts in England, and Patient Reported Outcome Measures (PROMs).
Participants

Patients undergoing primary planned TKR aged ≥18 years.
Intervention

ERAS implementation (April 2009–March 2011).
Outcomes

Regression coefficients of monthly means of Length of stay (LOS), bed day costs, change in Oxford knee scores (OKS) 6-months after surgery, complications (at 6 months), and rates of revision surgeries (at 5 years).
Results

486,579 primary TKRs were identified. Overall LOS and bed-day costs decreased from 5.8 days to 3.7 and from £7607 to £5276, from April 2008 to December 2016. Oxford knee score (OKS) change improved from 15.1 points in April 2008 to 17.1 points in December 2016. Complications decreased from 4.1 % in April 2008 to 1.7 % in March 2016. 5-year revision rates remained stable at 4.8 per 1000 implants years in April 2008 and December 2011. After ERAS, declining trends in LOS and bed costs slowed down; OKS improved, complications remained stable, and revisions slightly increased.
Conclusions

Different secular trends in outcomes for patients having TKR have been observed over the last decade. Although patient outcomes are better than a decade ago ERAS did not improve them at national level.

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More information

Accepted/In Press date: 1 May 2019
e-pub ahead of print date: 10 May 2019

Identifiers

Local EPrints ID: 431560
URI: http://eprints.soton.ac.uk/id/eprint/431560
ISSN: 1063-4584
PURE UUID: 743b8cba-ae7d-40dd-8dfd-6ed98dd1d307
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 07 Jun 2019 16:30
Last modified: 26 Nov 2021 06:12

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Contributors

Author: C. Garriga
Author: J. Murphy
Author: J. Leal
Author: A. Price
Author: D. Prieto-Alhambra
Author: A. Carr
Author: N. Arden
Author: A. Rangan
Author: C. Cooper ORCID iD
Author: G. Peat
Author: R. Fitzpatrick
Author: K. Barker
Author: A. Judge

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