Short-term outcomes of enhanced recovery after surgery (ERAS) for ankle fracture: a single-center retrospective cohort study

Abstract Background: Enhanced recovery after surgery (ERAS) has been successfully adopted for the improvement of medical quality and efficacy in many diseases but the effect among the ankle fracture patients is variable. We intended to explore the short-term outcomes of ERAS among ankle fracture patients. Methods: One hundred sixty ankle fracture participations (41.71 ± 14.51 years-old) grouped into two groups (non-ERAS Vs. ERAS) with an average of 24 months follow-up were included in the retrospective study. Multivariable linear regression analysis and generalized estimating equation (GEE) model were performed to assess the association of outcomes including American Orthopaedic Foot and Ankle Society (AOFAS), length of stay (LOS), and hospital cost. Results: Analysis revealed that the patients in the ERAS group could obtain higher AOFAS score with LOS or hospital cost reduction than that in the ERAS group ( p ＜0.05) at month 3 postoperatively (PO3M) and month 6 postoperatively (PO6M). However, outcomes were comparable at month 12 postoperatively (PO12M) and later.GEE analysis and group by time interaction of AOFAS revealed the ERAS protocol could help ankle fracture patients recover faster and better in the short-term. Conclusions: Ankle fracture patients could recover better with the application of the ERAS protocol, especially in the short-term periods, all patients would obtain comparable function PO12M later. The ERAS protocol might improve medical quality and efficacy by reducing LOS and hospital costs as well. The current study would provide a realistic evaluation and comparison of the ERAS protocol among the ankle fracture patients for the surgeons in the short-term.