Multidisciplinary Enhanced Recovery with Physiotherapy Integration: Impact on Functional Recovery and Length of Stay in Urological (TURBT), Colorectal (Perianal Fistula), and Orthopedic (Partial Hip Arthroplasty) Surgeries
DOI:
https://doi.org/10.48047/q47ty531Keywords:
Enhanced Recovery After Surgery (ERAS), Physiotherapy Integration, Functional Recovery, Length of Hospital Stay, Multidisciplinary Perioperative Care, Surgical Outcomes, Postoperative RehabilitationAbstract
Importance: The role of Enhanced Recovery After Surgery (ERAS) protocols has developed significantly in the realm of surgical specialties in garnering improved perioperative outcomes; however, recovery has been mostly assessed on the basis of hospital stays and less on functional independence. The role of integrating structured physiotherapy within existing ERAS protocols regarding functional recovery of various surgical procedures has mostly remained inadequately addressed.
Objective: To assess the relationship between the incorporation of physiotherapy in ERAS protocols and the recovery of functions as well as the length of stay in the hospital post-transurethral resection of bladder tumor (TURBT), perianal fistula repair, and hip arthroplasty.
Design, Setting, and Participants: In this multicenter, prospective cohort study, patients were enrolled between January 2020 and December 2023 in 3 tertiary care centers in Pakistan. Patients aged ≥ 18 years posted for surgery for Trans-Urethral Resection of Bladder Tumor (TURBT), perianal fistula, and/or partial hip arthroplasty were included, 1,847 patients screened, 556 (30%) patients were enrolled.
Exposures: Perioperative physiotherapy pathways integrated with ERAS care versus standard ERAS care without integrated physiotherapy pathways.
Main Outcomes and Measures: Time to meet preselected functional milestones and length of hospital stay. Secondary endpoints: Quality of life measured with EQ 5D 5L, complications, opioid intake, and re-admissions.
Outcome: The physiotherapy-integrated ERAS program reduced the time to reach functional endpoints by 48% for TURBT (HR, 1.92; CI, 95% range, 1.45-2.55), by 37% for perianal fistula surgery (HR, 1.78; CI, 95% range, 1.32-2.39), and by 39% for partial hip arthroplasty (HR, 2.13; CI, 95% range, 1.61-2.82) (all p <0.001). Mean hospital stay was reduced by 1.0 to 2.3 days depending on the operation (all p <0.001). The scores for quality-of-life outcome at 30 days were higher in the intervention arm (mean difference, 0.09; CI, 95% range, 0.06-0.12). No differences were found for the complication rate, although there were fewer cases of urinary retention after TURBT (6.5% vs 14.1%; P=0.04).
Conclusions and Relevance: Physiotherapy integrated ERAS care was linked with quick functional recovery and shorter stays in hospital in urology, colorectal, and orthopedic surgery without more complications, and these data support changing what constitutes success for enhanced recovery and encourage routine physiotherapy integration into enhanced recovery care.
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