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Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty:A systematic review and meta-analysis

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World Journal of Orthopedics 2022年第3期13卷 307-328页

作者： Marion JLF Heymans Nanne P Kort barbara am snoeker Martijn GM Schotanus Zuyderland Academy Zuyderland Medical CenterSittard 6155 NHNetherlands Department of Orthopedic Surgery CortoclinicsSchijndel 5482 WNNetherlands Department of Clinical Epidemiology Biostatistics and BioinformaticsAmsterdam Medical CenterUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of Orthopaedic Surgery and Traumatology Zuyderland Medical CenterSittard-Geleen 6162 BGLimburgNetherlands Care and Public Health Research Institute Maastricht University Medical CentreFaculty of HealthMedicine&Life SciencesMaastricht 6229 ERLimburgNetherlands

BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and *** The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee *** A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June *** randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were *** effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial *** possible,a meta-analysis was *** case of considerable heterogeneity among studies,a qualitative analysis was *** Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative *** total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of *** methodological quality of the included studies ranged from average to *** ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular *** analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported

关键词： Hip arthroplasty Knee arthroplasty Joint arthroplasty Clinical pathway Enhanced recovery pathway Systematic review Meta-analysis

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