Reducing Length of Stay Through an Enhanced Recovery After Surgery (ERAS) Pathway for ACL Reconstruction with Meniscus Repair: A Quality Improvement Project in a Malaysian Orthopaedic Hospital
Description
Description This dataset contains complete research data from a quality improvement project evaluating an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing anterior cruciate ligament (ACL) reconstruction with or without meniscus repair at a private orthopaedic hospital in Kuala Lumpur, Malaysia. Research Hypothesis The project hypothesised that implementation of a standardised ERAS pathway would significantly reduce hospital length of stay (LOS) from baseline (2.58 days) to ≤2.0 days within six months, achieve ≥95% multidisciplinary compliance, achieve ≥90% patient satisfaction, and maintain surgical site infection rates <1.5%. Data Collection Methods A pre-post intervention design was employed. Baseline data (n=36) were collected retrospectively from January to June 2025, and post-implementation data (n=55) were collected prospectively from July to December 2025 following ERAS implementation. Data sources included electronic medical records, patient satisfaction surveys (6-item, 5-point Likert scale), ERAS compliance checklists (30 items), and physiotherapy logs. LOS was defined as the number of nights from surgery to discharge. Variables Patient ID: Anonymous identifier Group: Pre-ERAS or Post-ERAS Age: Years (continuous) Sex: Male/Female (categorical) Surgery Type: ACLR only or ACLR + Meniscus Repair (categorical) LOS: Days (continuous) Month: Month of surgery (categorical) Patient Satisfaction: Scores across 6 domains (0–100%) ERAS Compliance: Percentage of checklist items completed Statistical Methods Data were analysed using Microsoft Excel. Descriptive statistics (means, medians, SDs, 95% CIs) were calculated. Mean LOS was compared using an independent t-test (p<0.05). Effect size (Cohen's d) was calculated. Run charts with standard rules (shift: ≥6 points above/below median; trend: ≥5 consecutive points increasing/decreasing) were generated. Key Findings Mean LOS decreased significantly from 2.58 days (SD 0.91; 95% CI: 2.27 to 2.89) pre-ERAS to 1.95 days (SD 0.56; 95% CI: 1.79 to 2.11) post-ERAS (mean difference: 0.64 days, 24.8%; t = 3.78, df = 52, p = 0.0004; Cohen's d = 0.82). Median LOS decreased from 2.5 to 2.0 days. Multidisciplinary compliance averaged 97.51%, exceeding the 95% target. Patient satisfaction averaged 95.98% across six domains. No surgical site infections were reported (0%). Interpretation The reduction in LOS is attributable to structured pre-operative education, standardised multimodal analgesia, early mobilisation, clear discharge criteria, multidisciplinary communication, and a dedicated Joint Navigator. The large effect size (d=0.82) and sustained shift on the run chart confirm clinically meaningful and durable improvement. How to Use This Data This dataset enables independent reproduction of statistical analyses, comparative meta-analyses, and benchmarking for institutions implementing similar ERAS pathways.
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Steps to reproduce
This quality improvement project employed a pre-post intervention design at a private orthopaedic hospital in Kuala Lumpur, Malaysia. A total of 91 patients undergoing primary ACL reconstruction with or without meniscus repair were included. Baseline data (n=36) were collected retrospectively from January to June 2025, and post-implementation data (n=55) were collected prospectively from July to December 2025 following ERAS pathway implementation. Inclusion criteria comprised all patients undergoing primary ACL reconstruction with and/or meniscus repair. Exclusion criteria included emergency/unplanned surgeries, infection cases, fractures involving tibial plateau or distal femur, multiple ligament injuries, and revision ACL reconstructions. An ERAS pathway was developed by a multidisciplinary team and implemented in July 2025. Pre-operative components included structured patient education by a Joint Navigator, prehabilitation exercises, surgi-bath, fasting guidelines (clear fluids 2 hours, solids 6 hours), and pre-medication (Celecoxib/Arcoxia + Paracetamol). Intra-operative components included standardised anaesthesia with nerve blocks, prophylactic antibiotics, multimodal analgesia, active warming, and no routine drains. Post-operative components included multimodal analgesia (paracetamol, NSAIDs, cryotherapy), antiemetics, early mobilisation (ambulation 6 hours post-op), phased physiotherapy (twice daily inpatient, then twice weekly for 6 weeks, then weekly for 3 months), and structured discharge planning. Data were collected from electronic medical records (demographics, LOS, SSI rates), patient satisfaction surveys (6-item, 5-point Likert scale), ERAS compliance checklists (30 items), and physiotherapy logs. Satisfaction scores were converted to percentages. Compliance rates were calculated as percentage of completed items. All data were analysed using Microsoft Excel. Descriptive statistics (means, medians, SDs, 95% CIs) were calculated. Mean LOS was compared using an independent t-test (p<0.05). Effect size (Cohen's d) was calculated manually. Run charts with median reference lines and intervention demarcation were generated to visualise trends. To reproduce: obtain electronic medical records for eligible ACLR patients; define LOS as nights from surgery to discharge; develop a 30-item ERAS checklist; administer a 6-item satisfaction survey (5-point Likert scale); collect data for pre- and post-implementation periods; compile in Excel; calculate descriptive statistics and perform t-tests; generate run charts to visualise monthly trends.