Does Enhanced Recovery after Surgery Protocol Improve Outcomes in Elderly Patients of Advanced Age Undergoing Primary Total Joint Replacement Surgery? A Preliminary Report

Background: Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted in joint reconstruction surgeries to reduce costs, improve efficiency, and optimize outcomes. Objectives: This study evaluates the preliminary effects of ERAS in elderly patients (>80 years) undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay (LOS), morbidity, and readmission rates. Materials and Methods: Patients who received elective TKA or THA from a single tertiary center were retrospectively reviewed. Two groups were compared: patients treated with standard care in 2023 and those recruited in the ERAS protocol from June to December 2024. Outcomes assessed contained mean age, LOS, morbidity, and 30-day readmission rates. Results: Among 56 patients in the non-ERAS group (mean age 84.1), the overall LOS was 7.61 days with 7 morbidity cases (12.5%) and no readmissions. In the ERAS group ( n = 14, mean age 83.2), LOS decreased to 7 days and no morbidity or readmissions were observed. For non-ERAS TKA and THA, LOS was longer (7.36 and 8.5 days, respectively) with higher morbidity rates (11% and 17%). Conclusions: Preliminary results suggest that ERAS ameliorate perioperative outcomes in elderly patients receiving joint replacement surgery, although the findings are exploratory and not definitive. Additional large-scale research is needed to confirm these findings and to clearly demonstrate the advantages of ERAS in Taiwan.