Background: Total hip replacement (THR) is a major surgical procedure that requires seamless coordination among anesthesiologists, surgeons, and postoperative care teams. The enhanced recovery after surgery (ERAS) protocol for THR emphasizes early mobilization, early oral intake, minimal antibiotic use, multimodal analgesia, and opioid-sparing techniques to optimize patient outcomes. These measures aim to reduce complications, shorten hospital stays, and improve patient satisfaction. This study reports 52 cases of THR performed safely at the Ho Chi Minh City Orthopedic and Rehabilitation Hospital (1A Hospital), despite limited operating room availability and workforce constraints. The initiative was carried out in the spirit of collaboration and knowledge sharing. This study aims to assess the safety and effectiveness of the ERAS protocol in THR surgery and evaluate methods for optimizing resources under limited conditions. Methods: This was a cross-sectional descriptive study conducted on 52 patients undergoing THR at 1A Hospital. Evaluated criteria included anesthetic technique, intraoperative drug and blood product usage, urinary catheterization, surgical drain placement, prophylactic antibiotic use, multimodal postoperative pain management, early mobilization time, early complications within 24 hours postoperatively, and length of hospital stay. Additionally, we describe strategies for optimizing human resources and equipment management to improve surgical safety and efficiency. Results: Among the 52 patients, 98.1% (51 cases) underwent neuraxial anesthesia, specifically spinal anesthesia with Marcaine Spinal Heavy. Tranexamic acid was administered to all patients to minimize intraoperative blood loss, and only 17.31% (nine cases) required blood transfusions. Urinary catheterization was not required in 57.69% of cases, and in those who required catheterization, catheters were removed immediately upon transfer to the ward. Surgical drains were placed in 9.62% of cases as part of postoperative fluid management. Prophylactic antibiotics were administered to all patients following the standard ERAS protocol, with three doses administered every 8 hours postoperatively. Postoperative pain management was primarily based on a multimodal analgesia regimen, including intra-articular bupivacaine infiltration, celecoxib, gabapentin, and paracetamol. The mean time to first mobilization was 7.98 ± 2.98 hours postoperatively, while the meantime to resume oral intake was 7.66 ± 1.59 hours. The average hospital stay duration is 13.18 ± 2.88 days. No early postoperative complications, including deep vein thrombosis, surgical site infections, or major hemodynamic instability, were recorded within the first 24 hours postoperatively. Finally, 100% of patients were discharged safely without significant adverse events. Conclusions: The implementation of ERAS principles in THR surgery, even under resource-limited conditions, significantly improved patient outcomes by reducing complications, shortening hospital stays, and facilitating early mobilization. This model can be replicated in similar healthcare settings to optimize surgical efficiency and enhance patient care.
Ta et al. (Mon,) studied this question.