Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty: A systematic review and meta-analysis

Table 3 Grading of Recommendation, Assessment, Development and Evaluation evidence profile: Enhanced recovery pathways compared to regular pathways for hip and knee arthroplasty

Quality assessment							No. of patients		Effect		Quality	Importance
													No. of studies
Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	(S)AE	Control	Relative (95%CI)	Absolute
Functional recovery (follow-up 24 mo)
12	Randomised trials	No serious risk of bias	Serious1	No serious indirectness	No serious imprecision	None	0/2289 (0%)	0/1802 (0%)	Not pooled	Not pooled	Moderate	Important
								0%		Not pooled
PROMs (follow-up 24 mo; Better indicated by lower values)
15	Randomised trials	No serious risk of bias	Serious2	No serious indirectness	No serious imprecision	None	2966	2388	-	Not pooled	Moderate	Important
LoS (follow-up 24 mo; Better indicated by lower values)
38	Randomised trials	No serious risk of bias	No serious inconsistency	No serious indirectness	No serious imprecision	None	997447	1573895	-	MD 2.45 lower (3.42 to 1.48 lower)	High	Important
(S)AEs
34	Randomised trials	No serious risk of bias	No serious inconsistency	Serious3	No serious imprecision	None	2103/18344 (11.5%)	83989/540864 (15.5%)	RR 0.91 (0.78 to 1.06)	14 fewer per 1000 (from 34 fewer to 9 more)	Moderate	Important
								11.7%		11 fewer per 1000 (from 26 fewer to 7 more)
Readmission (follow-up 24 mo)
23	Randomised trials	No serious risk of bias	No serious inconsistency	No serious indirectness	Serious4	None	273/9846 (2.8%)	8360/406167 (2.1%)	RR 0.83 (0.65 to 1.07)	3 fewer per 1000 (from 7 fewer to 1 more)	Moderate	Important
								2.7%		5 fewer per 1000 (from 9 fewer to 2 more)

¹Different outcomes for functional recovery: HHS [with/without range of motion (ROM), pain], American Knee Society Score, ROM.

²Different patient reported outcome measures: SF-36, WOMAC, KATZ.

³No clear distinction between adverse event (AE) and serious AE.

⁴Wide confidence interval.

(S)AE: (Serious) adverse event; CI: Confidence interval; PROMS: Patient reported outcome measures; LoS: Length of hospital stay; RR: Relative risk.