The Perioperative Surgical Home and Enhanced Recovery After Surgery: Perspectives from Two Continents

Abstract

The concept of enhanced recovery after surgery – ERAS – has been in practice in surgical practice in Europe since the 1990s, but its uptake in the United Kingdom has been more recent, and even more so its use in orthopaedic surgery. Encompassing 20 or so specific clinical practices, ERAS aims to reduce length of inpatient stay, minimise costs, and improve patient outcomes after surgery. Based on these same principles, a new model of care delivery has been developed in the United States, with similar aims. Under a multi-professional team, led by the Orthopaedic Surgeon and an Anaesthetist, this expands the provision of care from the moment the decision for surgery is made, to a period of 30 and even 90 days following discharge – what the American Society of Anesthesiologists have defined as the ‘Perioperative Surgical Home’. Preliminary results of the PSH model for patients undergoing arthroplasty surgery in the US have so far been promising. Surgical leadership must be provided to better utilise anaesthetic services in arthroplasty pathways, to reduce length of stay, readmission and move towards a model for care provision that extends to the entire perioperative period. The review aims to compare the perioperative surgical home to current UK practice and provide an evidence based summary of both surgical and non surgical interventions to help achieve a reduction in length of stay, decrease readmissions, and improve functional outcomes as well as a discussion of the potential for integrating some of its elements into current care models.