A Retrospective Cohort Study on The Impact of the Enhanced Recovery After Surgery with Safe Brain Initiative on Total Knee Arthroplasty Outcomes in Türkiye

Objective: Enhanced recovery after surgery (ERAS) protocols are recognised for improving postoperative outcomes. Integrating structured prehabilitation with the safe brain initiative (SBI) may further enhance these benefits. This study evaluated the impact of an ERAS-SBI programme on postoperative recovery and analgesic requirements in patients undergoing total knee arthroplasty (TKA). Methods: This retrospective single-centre cohort study included adults classified as American Society of Anesthesiologists I-III who underwent elective TKA at a tertiary-care teaching hospital. Outcomes of patients managed with the ERAS-SBI programme (n = 138; December 2023-2024) were compared with those of patients treated prior to programme implementation (n = 66; December 2022-2023). The primary outcome was the length of hospital stay. Secondary outcomes included timing of postoperative discharge and cumulative rescue opioid analgesia at 24 and 48 hours. Results: =0.003, respectively). Conclusion: Implementing an ERAS-SBI pathway, incorporating a dedicated prehabilitation-focused ERAS outpatient clinic, is associated with shorter hospitalisation and reduced postoperative analgesic requirements following TKA. These findings support the role of enhanced multidisciplinary perioperative optimisation in improving clinical outcomes.