A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery

Introduction

Orthopaedic enhanced recovery after surgery (ERAS) providers are encouraged to estimate the actual benefit of ERAS according to the patient’s opinion by using patient generated data alongside traditional measures such as length of stay. The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway.
Methods

Publications were identified using Embase™, MEDLINE®, AMED, CINAHL® (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index. Search terms related to experiences, acceptance, satisfaction or perception of ERAS and quality of life (QoL).
Findings

Of the 596 abstracts found, 8 papers were identified that met the inclusion criteria. A total of 2,208 patients undergoing elective hip and knee arthroplasty were included. Patient satisfaction was reported in 6 papers. Scores were high in all patients and not adversely affected by length of stay. QoL was reported in 2 papers and showed that QoL scores continued to increase up to 12 months following ERAS. Qualitative methods were used in one study, which highlighted problems with support following discharge. There is a paucity of data reporting on patient experience in orthopaedic ERAS. However, ERAS does not compromise patient satisfaction or QoL after elective hip or knee surgery. The measurement of patient experience should be standardised with further research.

Enhanced recovery after surgery (ERAS) seeks to optimise perioperative wellbeing by reducing the surgical stress response. 1 To date, the outcome of ERAS pathways has been measured using length of hospital stay (LOS), readmission and complication rates. However, there is now a drive to capture the patient's perspective and patient reported outcome measures (PROMs) have been used to do this. PROMs are validated measures of any aspect of health that come from the patients themselves. 2 They include satisfaction and quality of life (QoL) scores. Their collection for elective total hip and total knee arthroplasty patients has been mandatory in the National Health Service (NHS) since 2009. 3 Patient experience is another aspect of the patient's perspective, and is considered to have equal standing alongside clinical effectiveness and patient safety as an indicator of quality. 4
In the UK, patient experience data are collected using the NHS patient survey programme, the NHS friends and family test, 5 non-validated questionnaires, interviews and focus groups. 6 The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway.
Methods
Section:


Guidelines for the preferred reporting items for systematic reviews and meta-analysis were followed. 7 Embase™, MEDLINE®, AMED, CINAHL® (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index were searched. The search strategy is summarised in Table 1. The most recent search was performed on 8 February 2013.