Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

IntroductionEmerging evidence suggests that fast-track and enhanced recovery after surgery (ERAS) targeting modifiable risk factors reduce complications after total hip (THR) and knee replacement (TKR). However, what constitutes an effective preoperative optimisation protocol for THR and TKR remains unclear. The aims are to: (1) describe pre-operative optimisation protocols for THR and TKR; (2) evaluate the effects of pre-operative optimisation protocols for THR and TKR on morbidity, and patient-reported outcomes. Methods and analysisSystematic review and meta-analysis. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the study eligibility and risks of bias. Two independent reviewers will select the eligible studies and any disagreement will be resolved through a third reviewer. We will include studies investigated pre-operative optimisation protocols administered prior to participants receiving primary THR or TKR to improve post-operative outcomes. Primary outcomes are hospital readmission, complications and patient-reported pain and function. Risk of bias will be assessed using the Cochrane RoB 1 tool and strength of evidence will be examined using the GRADE approach. Pre-operative optimisation protocols will be summarised qualitatively. Meta-analyses on the effects of included protocols will be conducted if appropriate. Ethics and disseminationThis systematic review does not require ethics approval. The findings will be disseminated in a peer-reviewed journal and presented at relevant conferences. RegistrationThis protocol has been submitted to the International Prospective Register of Systematic Reviews on 30 August 2021. ARTICLE SUMMARYO_ST_ABSStrength and LimitationsC_ST_ABSO_LIThis systematic review aims to describe pre-operative optimisation protocols for total hip and knee replacement and to synthesise evidence for the effects of pre-operative optimisation protocols on hospital readmission, complications and patient-reported outcomes. C_LIO_LITwo independent reviewers will conduct study selection, data extraction and risk of bias assessment. C_LIO_LIMeta-analyses, sub-group and sensitivity analyses will be performed where appropriate. C_LI