BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been shown to benefit recovery after several operations. However, large-scale data on the association between the level of ERAS use and perioperative complications are scarce, particularly in surgeries with increasing ERAS uptake, including total hip (THA) and knee arthroplasty (TKA). Using US national data, we examined the relationship between the number of ERAS components implemented ('level') and perioperative outcomes. METHODS After ethics approval, we included 1 540 462 elective THA/TKA procedures (2006-2016, as recorded in the Premier Healthcare claims database) in this retrospective cohort study. Main outcomes were any complication, cardiopulmonary complications, mortality, blood transfusions, and length of stay. Eight commonly used ERAS components were included. Mixed-effects models measured associations between ERAS level and outcomes, with odds ratios (OR) and confidence intervals (CI) reported. RESULTS ERAS use increased over time; overall, 21.6% (n=324 437), 62.7% (n=965 953), and 18.0% (n=250 072) of cases were classified as 'High', 'Medium', or 'Low' ERAS. 'High ERAS', 'Medium ERAS', and 'Low ERAS' level of use were defined as such if they received either >6, 5-6, or <5 ERAS components, respectively. After adjustment for relevant covariates, higher levels of ERAS use were associated with incremental reductions in 'any complication': 'Medium' vs 'Low' (OR=0.84; CI, 0.82-0.86) and 'High' vs 'Low' (OR=0.71; CI, 0.68-0.74). Similar patterns were found for the other study outcomes. Individual ERAS components with the strongest effect estimates were early physical therapy, avoidance of a urinary catheter, and tranexamic acid administration. CONCLUSIONS ERAS components were used more frequently over time, and the level of utilisation was independently associated with incrementally improved complication odds and reduced length of stay during the primary admission. Possible indication bias limits the certainty of these findings.

中文翻译：

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手术后部件和围手术期结局的增强恢复：一项全国性的观察性研究。

背景技术已经表明，增强的术后恢复（ERAS）方案有益于几次手术后的恢复。但是，关于ERAS使用水平与围手术期并发症之间关系的大规模数据很少，尤其是在ERAS摄取量增加的手术中，包括全髋关节（THA）和膝关节置换术（TKA）。使用美国国家数据，我们检查了实施的ERAS组件数量（“水平”）与围手术期结局之间的关系。方法在伦理学批准后，我们​​纳入了这项回顾性队列研究的1 540 462选择性THA / TKA程序（2006-2016，记录在Premier Healthcare索赔数据库中）。主要结局为并发症，心肺并发症，死亡率，输血和住院时间。包括八个常用的ERAS组件。混合效应模型测量了ERAS水平与结果之间的关联，并报告了比值比（OR）和置信区间（CI）。结果随着时间的流逝，ERAS的使用有所增加；总体而言，21.6％（n = 324 437），62.7％（n = 965 953）和18.0％（n = 250 072）的案例被分类为“高”，“中”或“低” ERAS。如果“高ERAS”，“中ERAS”和“低ERAS”使用级别分别定义为分别接收到> 6、5-6或<5 ERAS组件，则被定义为这样。在对相关协变量进行调整之后，较高的ERAS使用量与“任何并发症”的逐渐减少相关：“中”与“低”（OR = 0.84； CI，0.82-0.86）和“高”与“低”（OR） = 0.71； CI，0.68-0.74）。其他研究结果也发现了类似的模式。估计效果最强的单个ERAS组件是早期物理治疗，避免使用导尿管和氨甲环酸。结论随着时间的流逝，ERAS组件的使用越来越频繁，利用率水平与初次入院时并发症几率的提高和住院时间的减少独立相关。可能的适应证偏差限制了这些发现的确定性。