Enhanced Recovery After Surgery program enables same-day hip and knee replacement surgeries during pandemic

New Orleans

— Adaptations to a program that helps ensure the best possible surgical outcomes have enabled eligible patients to receive their hip and knee replacement surgeries during the COVID-19 pandemic without spending the night in hospital . The changes were so successful they were permanently implemented at the facility, according to a quality improvement study presented at ANESTHESIOLOGY® Annual meeting 2022.

Championed by medical anesthesiologists, Enhanced Recovery After Surgery (ERAS) programs mitigate the effects of surgery and speed up patient recovery.

In 2019, Stony Brook Medicine in New York implemented an ERAS program for elective hip and knee replacement surgeries, with all patients spending at least one night in the hospital following the procedure. However, during the pandemic, the team revised the ERAS program so that selective patients could benefit from an outpatient procedure, meaning they did not spend the night in the hospital.

The new ERAS protocol included:

  • Develop a highly selective screening process to identify patients who would be good candidates for day surgery (ie, relatively healthy, highly motivated with a good home support system).
  • Use of a shorter-acting spinal anesthetic.
  • Hydrate patients before the procedure and limit fluids used during surgery.
  • Minimize the use of urinary catheters to prevent infections.
  • Improve pain management by sending patients home with a non-opioid pain pump.
  • Ensure follow-up at home, including visits by nurses and physiotherapists.

“We have found that for many patients, same-day surgeries are a safe alternative to an extended hospital stay,” said Sunitha Singh, MD, lead author of the Quality Improvement Project and program coordinator. ERAS at Stony Brook Medicine. “Patient education, pre-habilitation and engagement are key to the recovery process. Patients often feel more rested when recovering at home in familiar surroundings, and we have made the ERAS changes permanent due to the high success.

Elective surgeries at Stony Brook Medicine were halted at the height of the pandemic (April-May 2020). The hospital implemented the new ERAS protocol from June 2020 to ensure continuity of care.

Over a one-year period, 152 patients underwent knee or hip replacement surgery under the new program. Compared to patients who had the traditional ERAS protocol, patients in the new ERAS program stayed in hospital for an average of eight hours compared to an average of 1.7 days. No readmissions were reported. Currently, approximately 40% of hip and knee replacement patients participate in the ERAS day surgery program.

“Our results demonstrate the adaptability of our healthcare system – including the use of ERAS programs to respond to healthcare emergencies – while improving the quality of care,” Dr. Singh said.


Founded in 1905, the American Society of Anesthesiologists (ASA) is a teaching, research, and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. The ASA is committed to ensuring that physician anesthesiologists assess and supervise patients’ medical care before, during, and after surgery to provide the highest quality and safest care that every patient deserves.

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Ryan H. Bowman