Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

[Importance] The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.[Objective] To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).[Design, Setting, and Participants] This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019.[Exposures] Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not.[Main Outcomes and Measures] The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality.[Results] During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001).[Conclusions and Relevance] An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.This study was supported by institutional and/or departmental sources. The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) study was supported by the Spanish Perioperative Audit and Research Network (REDGERM

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2).

The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P  An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes

Anales de Edafología y Agrobiología Tomo 45 Número 3-4

I. Suelos. Física. Estudio de algunos factores que influyen en la formación de microagregados en los suelos del N.W. de España. Por E. Benito Rueda y F. Diaz-Fierros Viqueira.-- l. Suelos. Química. Comportamiento de la materia orgánica del suelo sometida a hidrolisis ácida: l. Seguimiento de la liberación de monómeros alfa-aminados. Por S. González Carcedo y M. C. Garcia Melus.-- Transformaciones del fósforo en suelos gallegos sometidos a incubación. Por M. C. Trasar Cepeda, F. Gil Sotres y F. Guilián Ojea.-- Dinámica de carbonatos en suelos desarrollados sobre areniscas. Por J. Batlle, J. R. Miñambres y J. L. Martin.-- Aplicación de técnicas de disolución selectiva al estudio de los componentes no cristalinos de una secuencia de sue los sobre granito en la Sierra de Ancares (Lugo, Galicia). Por E. García-Rodeja Gayoso y F. Macías Vázquez-- Movilización y fijación biológica de cationes en ecosistemas forestales. II: Dinámica del K en los horizontes superficiales del suelo. Por A. Garcia- Villaraco y F. Velasco de Pedro.--Determinación de la cinética de reacción del quelato Mnhedta en un suelo calizo mediante EUF (Electroultrafiltración). Por J. Sánchez-Andreu. Mª C. Sebastián Alafont, M. Juárez Sanz y J. Jordá Guijarro.-- l. Suelos. Biología. Estudio de la población microbiana de diversos tipos de suelo de zona húmeda (N.O. de España). Por Mª J. Acea y T. Carballas.--Distribución de la población microbiana de un podsol férrico húmico. Por Mª J. Acea y T. Carballas.-- l. Suelos. Génesis, Clasificación y Cartografía: Formaciones edáficas del sector N.E. de la provincia de Cuenca. (IV) Alfisoles. Por J. Batlle Sales, J. Gumuzzio Fernández y J. L. Martin de Vidales.--Suelos desarrollados sobre sedimentos calizos no consolidados en el Valle del Guadalquivir. II. Génesis y evaluación de los suelos. Por J. L. de Olmedo Pujol.-- Contribución al estudio micromorfológico de suelos de Galicia, sometidos a distintas condiciones de hidromorfia. Por M. C. Leiros de la Peña y .M. C. Villar Celorio.-- Contribución a la identificación micromorfológica de horizontes cámbicos en España. l. Cambisoles cálcicos. Por J. Aguilar Ruiz, T. Rodriguez Rebollo y G. Delgado Calvo-Flores-- l. Suelos-- Fertilidad. Factores que definen la fertilidad de los suelos determinados por diversos métodos de análisis factorial. Por M. T. Estañ, M. G. Guillén, .H. C. Bolarin y M. Caro.-- II. Biología Vegetal. Nutrición. Metodología de extracción de proteínas en hojas de citrus. Por R. M. Esteban Alvarez, E. Molla Lorente y O. Carpena Artés.-- II. Biología Vegetal. Fisiología - Evolución de los ácidos tartárico y málico durante la maduración de uvas Cayetana y Pardina (Variedades vitis vinífera). Por F. Henao, J. L. Mesias, J. l. Maynar y C. Miguel.-- Influencia de la concentración de nutrientes (N, P y K) sobre la germinación de semillas de alfalfa (Medicago sativa L.). Por F. l. Pugnaire de Iraola.-- II. Biología Vegetal. Agrobiología. Composición mineral de las hojas de aguacate. (Persea americana Mili.) en plantaciones comerciales de la provincia de Málaga (España). II. Microelementos. Por S. Jaime Palacio, J. M. Farré Massip y A. Aguilar Villalvilla.-- Intensa variabilidad interpoblacional en el piornal serrano (Formaciones de Cytisus balansae [Boiss.] Ball). Por B. Fernández Santos, J. M. Gómez Gutiérrez y M. S. Moreiro Clemente.-- III. Bibliografía.-- IV. NotasPeer reviewe