Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from 'The National Joint Registry of England and Wales'.

Effects of the UK Department of Health's national Enhanced Recovery After Surgery (ERAS) Programme on outcomes after primary hip replacement. Natural experimental study using interrupted time series to assess the changes in trends before, during and after ERAS implementation (April 2009 to March 2011). Surgeries in the UK National Joint Registry were linked with Hospital Episode Statistics containing inpatient episodes from National Health Service trusts in England and patient reported outcome measures. Patients aged ≥18 years from 2008 to 2016. Regression coefficients of monthly means of length of hospital stay, bed day cost, change in Oxford Hip Scores (OHS) 6 months post-surgery, complications 6 months post-surgery and revision rates 5 years post-surgery. 438 921 primary hip replacements were identified. Hospital stays shortened from 5.6 days in April 2008 to 3.6 in December 2016. There were also improvements in bed day costs (£7573 in April 2008 to £5239 in December 2016), positive change in self-reported OHS from baseline to 6 months post-surgery (17.7 points in April 2008 to 22.9 points in December 2016), complication rates (4.1% in April 2008 to 1.7% March 2016) and 5 year revision rates (5.9 per 1000 implant-years (95% CI 4.8 to 7.2) in April 2008 to 2.9 (95% CI 2.2 to 3.9) in December 2011). The positive trends in all outcomes started before ERAS was implemented and continued during and after the programme. Patient outcomes after hip replacement have improved over the last decade. A national ERAS programme maintained this improvement but did not alter the existing rate of change.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf and declare: AJ has received consultancy fees from Freshfields Bruckhaus Deringer, and has held advisory board positions (which involved receipt of fees) from Anthera Pharmaceuticals, INC. AP reports personal fees from Zimmer Biomet, outside the submitted work. AR reports grants from DePuy Ltd outside the submitted work. CC received personal fees from: Alliance for Better Bone Health; Amgen; Eli Lilly; GSK; Medtronic; Merck; Novartis; Pfizer; Roche; Servier; Takeda; UCB, outside the submitted work. NKA received grants and personal fees outside the submitted work from: Bioberica; Merck; Flexion; Regeneron; Freshfields Bruckhaus Deringer. DPA received grants from: Amgen; UCB Biopharma; Servier; Astellas; Novartis, outside the submitted work. All other authors declare no conflicts of interest.