The efficacy of ERAS-related components in orthopedic trauma surgery: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Orthopaedic trauma surgery is associated with significant perioperative morbidity, prolonged hospital stays, and increased healthcare costs. Enhanced Recovery After Surgery (ERAS) protocols have shown benefits in elective procedures; however, their role in orthopaedic trauma remains unclear. This study aimed to evaluate the efficacy of key ERAS related components in this setting.

METHODS

A systematic search of PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing ERAS related components with standard care in adult orthopaedic trauma patients were included. The primary outcome was hospital length of stay (LOS), while secondary outcomes included postoperative pain, functional recovery, deep vein thrombosis (DVT), blood transfusion requirement, postoperative haemoglobin, and infection rates. Data were analysed using RevMan 5.4.1, with risk of bias and evidence certainty assessed using Cochrane RoB 2.0 and GRADE approaches.

RESULTS

Five RCTs involving 423 patients were included. ERAS related components significantly reduced length of hospital stay (MD: -2.56 days; 95% CI: -4.43 to - 0.69; p = 0.007) and postoperative pain (MD: -1.12; 95% CI: -1.35 to - 0.88; p < 0.00001). No significant differences were observed in functional recovery, pain at rest or movement, DVT, blood transfusion, or postoperative haemoglobin. Postoperative infection rates were higher in the ERAS related component group but not statistically significant. Evidence certainty ranged from low to moderate.

CONCLUSION

ERAS-related components may reduce hospital length of stay and postoperative pain in adults undergoing orthopedic trauma surgery. However, certainty remains limited by the small number of trials, heterogeneity of interventions and trauma populations, and sparse safety events. Safety remains uncertain, particularly because postoperative infection was numerically higher and the DVT estimate was unstable after sensitivity analysis. Larger multicenter RCTs with standardized interventions are required.