Objective: To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity.
Methods: Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups ( P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation ( P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient's satisfaction were recorded.
Results: The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group ( P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points ( P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation ( P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points ( P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group ( P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence ( P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups ( P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant ( P>0.05).
Conclusion: For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.
目的: 探讨加速康复外科（enhanced recovery after surgery，ERAS）对高合并症患者人工全髋关节置换术（total hip arthroplasty，THA）术后功能及疼痛的影响。.
方法: 以2020年1月—2022年1月拟行THA患者作为研究对象，共223例高合并症患者符合选择标准纳入研究。采用随机信封法将患者分为两组，其中112例围术期按照ERAS方案处理（ERAS组），111例采用传统方案处理（对照组）。两组患者性别、年龄、身体质量指数、Charlson合并症指数以及术前诊断、合并症类型及数量、术前疼痛视觉模拟评分（VAS）等基线资料比较，差异均无统计学意义（ P>0.05）；但术前ERAS组Harris评分低于对照组，差异有统计学意义（ P<0.05）。记录患者术前及术后住院时间。术前、术后1 d、术后首次下床、出院当天、术后2周，采用VAS评分评估疼痛程度；术前以及术后 2 周，1、3、6、12个月，采用Harris评分评价髋关节功能；记录患者术后1年内并发症及死亡发生率、30 d内再入院率以及患者满意度。.
结果: ERAS组术前住院时间较对照组缩短（ P<0.05），但术后住院时间差异无统计学意义（ P>0.05）。两组患者均获随访12个月。两组组内术后VAS评分较术前降低，且随时间延长呈逐步下降趋势，各时间点间差异均有统计学意义（ P<0.05）；术后各时间点ERAS组VAS评分均低于对照组（ P<0.05）。两组组内术后Harris评分均较术前提高，且随时间延长呈逐步增加趋势，各时间点间差异均有统计学意义（ P<0.05）；同时术后2周及1、3个月ERAS组Harris评分高于对照组，差异有统计学意义（ P<0.05）。ERAS组2例（1.79%）、对照组6例（5.41%）发生并发症，并发症发生率差异无统计学意义（ P>0.05）。对照组1例术后30 d内再入院、1例1年内因重症肺炎死亡，ERAS组无再入院及死亡患者；两组术后30 d内再入院率、1年内死亡率差异均无统计学意义（ P>0.05）。末次随访时，ERAS组患者满意率高于对照组，但差异无统计学意义（ P>0.05 ）。.
结论: 高合并症THA患者实施ERAS方案能缩短术前等待时间，更好地减轻患者疼痛，改善患者髋关节功能。.
Keywords: High comorbidity; enhanced recovery after surgery; perioperative period; total hip arthroplasty.