Can enhanced recovery reduce length of stay after ankle replacement surgery?

K. Jain, T. Karim, J. Davenport, M. Karski, R. Smith, T. Clough

Background: Enhanced recovery is well established in knee replacements. No study has investigated the results of enhanced recovery (ER) after ankle replacements. The aim of this study was to compare the length of stay, postoperative pain, nausea and sedation, complications and readmission rates in patients undergoing ankle replacements with and without enhanced recovery.

Methods: Enhanced recovery (pre-op education, health optimisation, discharge planning, intra-op local infiltration analgesia, postop early mobilisation, nonopioid analgesia and discharge when safe) was followed for all primary total ankle replacements from 01 December 2014 onwards. 30 patients in the enhanced recovery cohort were compared with a previous consecutive 30 patients (Jan - Nov 2014). Pain, nausea and sedation were scored from 0 to 3 in all patients prospectively with 0 being none, 1 being mild, 2 being moderate and 3 being severe. The mean scores were compared using Student T test.

Results: The mean ages in the ER and control groups were 64 and 65 years respectively. There was no difference in pre-operative diagnoses between the 2 groups. There was a significant difference in the mean Day0 and Day1 pain scores for the two groups (Day0: ER:Control 0 v 0.6; p=0.003) and (Day1: ER:Control 0 v 0.7; p=0.005). There was no statistically significant difference in the nausea and sedation scores. There was significant reduction in the mean length of stay from 4.1 days in the control group to 1.7 days in the ER group (p = 0.02). There was no difference in the readmission and complication rates.

Conclusions: Postoperative length of stay and pain scores are significantly improved in the ER cohort compared to the non ER cohort.