The efficacy of ERAS-related components in orthopedic trauma surgery: a systematic review and meta-analysis of randomized controlled trials
In brief
ERAS protocols shorten orthopedic trauma stay by 2.5 days and reduce pain
A meta-analysis of five randomized trials (423 patients) found that adding ERAS components to standard care reduced hospital length of stay by an average of 2.5 days and lowered postoperative pain scores by about one point. Functional recovery, DVT, transfusion and haemoglobin were unchanged, and infection rates were numerically higher but not statistically different, leaving safety uncertain.
- Journal
- European journal of orthopaedic surgery & traumatology : orthopedie traumatologie (Q1)
- Published
- 3 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Deepa Lachhman Das, Ume Aiman, Umer Bin Shahzad, Tayyaba Malik, Talha Ilyas Khan, Muhammad Ahmed, et al.
- PMID
- 42545517
- DOI
- 10.1007/s00590-026-04895-8
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 9 August 2026).
- Picked for Emergency Medicine (top studies of the week, 9 August 2026).
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 9 August 2026): ERAS in orthopedic trauma
- Picked for Infectious Diseases (top studies of the week, 9 August 2026).
- Picked for Orthopedics and Sports Medicine (top studies of the week, 9 August 2026).
- Picked for Surgery (top studies of the week, 9 August 2026): Systematic review/meta‑analysis of ERAS in orthopedic trauma
- Picked for Hematology (top studies of the week, 9 August 2026).
- Picked for Public Health, Environmental and Occupational Health (top studies of the week, 9 August 2026).
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.