Table 1 Study and participant characteristics
First author, year of publication | Country | Surgical procedure (% intervention group) | Number of participants: n | % Female | Mean (SD) or median [IQR] age in years | Brief description of short-stay intervention | Brief description of usual care | Maximum study follow-up time |
|---|---|---|---|---|---|---|---|---|
Randomised controlled trials (parallel arm design) | ||||||||
 Fransen et al. 2018 [57] | Netherlands | TKR | Short-stay: 25 Usual care: 24 | Short-stay: 56 Usual care: 37 | Short-stay: 64 (9) Usual care: 61 (7) | - Mean LoS 2 days - No tourniquet, intra-operative local infiltration and analgesia, no pain pumps, wound drains, or bladder catheters were used | - Mean LoS 4 days - Regular hospital TKR protocol, including the use of a tourniquet, wound drains, and bladder catheter | 12 weeks |
 Petersen et al. 2006 [61] | Denmark | THR | Short-stay: 27 Usual care: 30 | Short-stay: 56 Usual care: 47 | Median [range] Short-stay: 55 [28–84] Usual care: 58 [26–81] | - No difference found in the LoS - Received an optimisation pack involving pre- and post-operative strategies in addition to usual care | - No difference found in the LoS - Standard pre- and post-operative multimodal anaesthesia and analgesia | 30 days |
 Reilly et al. 2005 [33] | United Kingdom | Unicompartmental knee replacement | Short-stay: 21 Usual care: 20 | Short-stay and usual care: 41 | Short-stay and usual care: 63 | - Mean Los 1.5 days - Facilitated discharge and discharge support in addition to usual care | - Mean LoS 1.5 days - Standard surgical, anaesthetic, and analgesic protocol | 6 weeks |
Registry studies | ||||||||
 Berg et al. 2018 [65] | Sweden | THR (56) TKR (44) | Short-stay: 7,270 Usual care: 6,640 | Short-stay: 57 Usual care: 57 | Short-stay: 70 (10) Usual care: 70 (10) | - Median LoS 3 days for THR and TKR - Admission on the day of surgery, early mobilisation, functional discharge, LoS ≤ 3 days | - Median LoS 5 days for THR and TKR - Minimum of written and oral patient information, multimodal analgesia, tranexamic acid | 3 months |
 Berg et al. 2021 [64] | Sweden | THR (53) TKR (47) | Short-stay: 67,672 Usual care: 48,621 | Short-stay: 56 Usual care: 58 | Short-stay THR: 68 (10) Usual care THR: 69 (10) Short-stay TKR: 69 (9) Usual care TKR: 70 (9) | - Median LoS 3 days for THR and TKR - Admission on the day of surgery, early mobilisation, functional discharge, LoS ≤ 3 days | - Median LoS 5 days for THR and TKR - Minimum of written and oral patient information, multimodal analgesia, tranexamic acid | 90 days |
Interrupted time series studies | ||||||||
 Alvis et al. 2021 [38] | United States | THR (33) TKR (67) | Short-stay: 186 Usual care: 96 | Short-stay: 9 Usual care: 12 | Short-stay: 65 (9) Usual care: 63 (9) | - Median LoS 2 days - Involvement of the Anaesthesia Perioperative Care Service for patients in the presurgical and post-discharge period | - Median LoS 3 days - Preoperative, intraoperative, and postoperative patient care in the hospital only | 30 days |
 Amlie et al. 2016 [71] | Norway | THR | Short-stay: 239 Usual care: 4,167 | Short-stay: 72 Usual care: 67 | Female: 71 (10) Male: 67 (11) | - LoS not reported - Four main components: (1) local anaesthetic, (2) cessation of negative vacuum suction drain, (3) early mobilisation, (4) standardised pain management | - LoS not reported - Patients who received only the standardised pain management protocol | 3 days |
 Arshad et al. 2014 [25] | England | THR (50) TKR (50) | Short-stay: 48 Usual care: 48 | Short-stay: 40 Usual care: 65 | Short-stay: 76 [68–82] Usual care: 75 [67–82] | - Median LoS 4 days - Preoperative education, regional anaesthesia, early mobilisation, and avoidance of drains and catheters | - Median LoS 5 days - No education on patient LoS, post-operative physiotherapy commenced the day after surgery | 6 weeks |
 Azam et al. 2022 [69] | India | Bilateral TKR | Short-stay: 275 Usual care: 190 | Short-stay: 72 Usual care: 66 | Short-stay: 66 (9) Usual care: 66 (10) | - Median LoS 3.9 days - 9 evidence-based interventions across the pre-operative, intraoperative, and postoperative period | - Median LoS 7.5 days - No usual care patients had any peripheral nerve blocks post-operatively, and epidural catheters were left in place for 24 h | 6 weeks |
 Chung et al. 2021 [45] | China | THR (47) TKR (53) | Short-stay: 111 Usual care: 117 | Short-stay: 60 Usual care: 67 | Short-stay: 70 (9) Usual care: 68 (12) | - Mean LoS 3.28 days - Higher dose of IV steroids, optimised management of pain, nausea and vomiting, blood management, sleep management, and same-day rehabilitation | - Mean LoS 5.16 days - Usual care patients received generally similar treatment to short-stay patients (except for the specific short-stay components listed), but these treatments are not described | 30 days |
 de Carvalho Almeida et al. 2021 [67] | Brazil | THR including same-day bilateral surgery | Short-stay: 47 Usual care: 51 | Short-Stay: 57 Usual care: 51 | n (%) Short-stay: ≤ 49: 15 (32) Usual care: ≤ 49: 13 (25) Short-stay: 50–59: 16 (34) Usual care: 50–59: 17 (33) Short-stay: ≥ 60: 16 (34) Usual care: ≥ 60: 21 (41) | - Mean LoS 2.3 days - Patient education and multidisciplinary care mandatory, the introduction of tranexamic acid, no opioids or bladder catheters, peri-articular injection, no ICU support, and early mobilisation | - Mean LoS 6.4 days - No detailed information about the surgery, multidisciplinary approach not encouraged, opioids routinely used, bladder catheter routinely used, ICU support mandatory, functional rehabilitation commenced on the first or second postoperative day. No functional discharge criteria | 3 months |
 den Hartog et al. 2013 [55] | Netherlands | THR | Short-stay: 384 Usual care: 157 | Short-stay: 69 Usual care: 68 | Short-stay: 71 (10) Usual care: 71 (10) | - Mean LoS 2.9 days - 10 evidence-based interventions across the pre-operative, intraoperative, and postoperative period | - Mean LoS 4.6 days - Functional discharge criteria, sufficient pain treatment required before discharge (encompassing 2/10 interventions) | 3 months |
 Dhawan et al. 2017 [26] | England | TKR | Short-stay: 50 Usual care: 70 | Short-stay: 42 Usual care: 40 | Median [range] Female: 70 [42–90] Male: 72 [55-81] | - LoS reduced by 1.5 days in both males and females - Local anaesthetic, tourniquets released before closure, homeostasis obtained, no drains used | - LoS not reported - No usual care components reported | During admission |
 Didden et al. 2019 [56] | Netherlands | TKR | Short-stay: 85 Usual care: 85 | Short-stay: 60 Usual care: 64 | Mean [range] Short-stay: 69 [52–86] Usual care: 69 [47–86] | - Median LoS 4 days - Local infiltration analgesia, oxycodone as needed only, mobilisation started 4 h after surgery, targeted discharge as soon as possible after surgery | - Median LoS 7 days - Epidural analgesia or femoral nerve block, prolonged-release oxycodone for a maximum of 10 days post-discharge, mobilisation started the day after surgery, targeted discharge 4 days after surgery | 90 days |
 Doman et al. 2012 [39] | United States | THR (39) TKR (61) | Short-stay: 90 Usual care: 85 | Short-stay: 38 Usual care: 58 | Short-stay: 62 Usual care: 59 | - Mean LoS 2.6 days - Patient education was used to guide recovery expectations, preoperative pain medication was initiated the morning of surgery, IV sedation was encouraged, efforts were made to use the minimal incision length and early mobilisation | - Mean LoS 5.5 days - No preoperative analgesia, the surgical technique did not emphasise smaller incisions, no established pain regimen, patients discharged once the pain was controlled via oral medication | 30 days |
 Dwyer et al. 2012 [37] | United Kingdom | THR | Short-stay: 64 Usual care: 63 | Short-stay: 58 Usual care: 65 | Short-stay: 70.1 (8.8) Usual care: 72.5 (8.7) | - Mean LoS 5.3 days - Preadmission, preoperative, intraoperative, and postoperative interventions but with a focus on preoperative and postoperative nutrition | - Mean LoS 8.3 days - Usual care pathway not reported | Not reported, but outcomes are provided up to 81 days postop |
 Dwyer et al. 2014 [27] | United Kingdom | TKR | Short-stay: 57 Usual care: 55 | Short-stay: 70 Usual care: 60 | Short-stay: 71 (9) Usual care: 73 (9) | - Mean LoS 6 days - Preadmission interventions of multidisciplinary and holistic care and family involvement, and 10 evidence-based interventions across the pre-operative, intraoperative, and postoperative period | - Mean LoS 7.8 days - Patients admitted the evening before surgery, spinal or general anaesthesia used, mobilisation not started until the day after surgery, no routine physiotherapy | 3 weeks |
 Featherall et al. 2018 [40] | United States | THR | Short-stay: 2,081 Usual care: 1,033 | Short-stay: 50 Usual care: 50 | Short-stay: 64 (12) Usual care: 64 (12) | - Mean LoS 2.55 days - Preoperative assessment and risk factor modification, antibiotic prophylaxis, tranexamic acid, operating room adjustments, and standardised postoperative care | - Mean LoS 3.21 days - Usual care pathway not described | 90 days |
 Galbraith et al. 2017 [70] | Ireland | THR (40) TKR (60) | Short-stay: 165 Usual care: 145 | Short-stay: 42 Usual care: 48 | Not reported | - Mean LoS 5.1 days - Multidisciplinary care, optimisation of pre-existing conditions, drains not used, local infiltration analgesia, tranexamic acid, early mobilisation | - Mean LoS 8.79 days - Admitted the day before surgery, spinal or general anaesthesia used, analgesics provided, opioids commonly used for pain, mobilisation 1-day post-surgery | 90 days |
 Gleicher et al. 2021 [58] | Canada | TKR | Short-stay: 383 Usual care: 232 | Short-stay: 60 Usual care: 64 | Short-stay: 67 (10) Usual care: 66 (10) | - Mean LoS 2.13 days - Postoperative analgesia, nausea and vomiting prophylaxis, Foley catheterisation, patient education | - Mean LoS 2.81 days - Perioperative placement of adductor canal block, IV dexamethasone, avoid unnecessary Foley catheterization, patient education not a focus | 30 days |
 Gwynne-Jones 2017 [62] | New Zealand | THR (61) TKR (39) | Short-stay: 528 Usual care: 507 | Short-stay: 54 Usual care: 54 | Short-stay THR: 68 (12) Usual care THR: 67 (12) Short-stay TKR: 70 (9) Usual care TKR: 70 (9) | - Mean LoS THR 4.3 days - Mean LoS TKR 4.8 days - Optimisation of pre-existing conditions, patient education, standardised anaesthesia and analgesia, blood management, early mobilisation | - Mean LoS THR 5.6 days - Mean LoS TKR 5.7 days - Usual care pathway not described | 90 days |
 Harkouk et al. 2021 [49] | France | THR (13) TKR (27) | Short-stay: 203 Usual care: 294 | Short-stay: 66 Usual care: 67 | Short-stay THR: 66 (14) Usual care THR: 68 (12) Short-stay TKR: 68 (12) Usual care TKR: 71 (11) | - Mean LoS THR 8.2 days - Mean LoS TKR 7.1 days - Staff education | - Mean LoS THR 8.2 days - Mean LoS TKR 8.7 days - No staff education | 30 days |
 Joo et al. 2022 [66] | Australia | THR (34) TKR (66) | Short-stay: 146 Usual care: 143 | Short-stay: 49 Usual care: 50 | Short-stay: 69 (9) Usual care: 69 (9) | - Mean LoS 2.29 days - Early mobilisation, functional discharge criteria | - Mean LoS 3.24 days - Mobilisation the day post-surgery, no functional discharge criteria | 3 months |
 Khan et al. 2014 [28] | United Kingdom | THR (42) TKR (58) | Short-stay: 3000 Usual care: 3000 | Short-stay: 54 Usual care: 51 | Short-stay: 68 (10) Usual care: 69 (10) | - Mean LoS 3 days - Pharmacological (low-dose spinal anaesthesia), procedural (early mobilisation), and behavioural (Patient and staff education) interventions | - Mean LoS 6 days - Pharmacological (general anaesthesia), procedural (catheterisation and next-day mobilisation), and behavioural (generic patient and staff education) interventions | 90 days |
 Larsen et al. 2008 [60] | Denmark | THR TKR | Short-stay: 142 Usual care: 105 | Not reported | No reported | - Mean LoS 4.4 days - Preoperative assessment and information, nutrition optimisation, early mobilisation | - Mean LoS 8.8 days - Patients received identical operation procedures, pain relief medication, and nausea controls | 90 days |
 Maempel et al. 2015 [30] | United Kingdom | TKR | Short-stay: 84 Usual care: 81 | Short-stay: 50 Usual care: 54 | Short-stay: 70 (9) Usual care: 70 (11) | - Mean LoS 3 days - Patient education, spinal anaesthesia, tranexamic acid, early mobilisation | - Mean LoS 4 days - Spinal anaesthesia, tranexamic acid, patient-controlled analgesia | During admission |
 Maempel et al. 2016 [29] | United Kingdom | THR | Short-stay: 550 Usual care: 611 | Short-stay: 62 Usual care: 60 | Short-stay: 64 [16] Usual care: 66 [15] | - LoS reduced by a mean of 1.5 days - Patient education, functional discharge criteria, spine anaesthetic, early mobilisation | - LoS not reported - Post-controlled analgesia, mobilisation 1-day post-surgery, a spine anaesthetic, | During admission |
 Malviya et al. 2011 [31] | United Kingdom | THR (42) TKR (58) | Short-stay: 1500 Usual care: 3000 | Short-stay: 53 Usual care: 51 | Short-stay: 68 Usual care: 69 | - Mean LoS 3 days - Targeted patient and staff education, low-dose spinal anaesthesia, tranexamic acid, local anaesthetic, early mobilisation, functional discharge criteria | - Mean LoS 6 days - Generic patient and staff education, general anaesthesia, catheterisation, mobilisation 1-day post-surgery, patient-controlled analgesia | 60 days |
 McDonald 2012 [32] | United Kingdom | TKR | Short-stay: 1081 Usual care: 735 | Short-stay: 59 Usual care: 42 | Short-stay: 69 (11) Usual care: 71 (13) | - Mean LoS 4 days - Patient education, perioperative multimodal analgesia, local intra-articular injection, and early mobilisation | - Mean LoS 6 days - Tranexamic acid, spinal anaesthesia, mobilisation 1-day post-surgery | 90 days |
 Picart et al. 2021 [50] | France | TKR | Short-stay: 216 Usual care: 335 | Short-stay: 63 Usual care: 66 | Short-stay: 69 (8) Usual care: 69 (10) | - Mean LoS 6.12 days - Patient education, no perineural block, tourniquet, or drainage, tranexamic acid, early mobilisation | - Mean LoS 6.30 days - Surgery under perineural block and tourniquet, post-operative drainage | 90 days |
 Raphael et al. 2011 [59] | Canada | THR (57) TKR (43) | Short-stay: 100 Usual care: 100 | Short-stay: 48 Usual care: 53 | Short-stay: 65 (9) Usual care: 69 (8) | - Mean LoS 47 h - Patient education, pre-emptive analgesia, patient-controlled opioid analgesia, early mobilisation, and functional discharge criteria | - Mean LoS 116 h - Limited patient education, no standardised pre or post-operative multimodal analgesia, use of peripheral nerve block for postoperative analgesia mobilisation 1-day post-surgery | 30 days |
 Romano et al. 2021 [53] | Italy | THR (52) TKR (48) | Short-stay: 122 Usual care: 59 | Short-stay: 45 Usual care: 53 | Short-stay: 70 [64-77] Usual care: 73 [68-77] | - Median LoS 5 days - Preadmission care, preoperative and intraoperative care, and postoperative care with a focus on patient education, anaesthesia and pain control, wound management and early mobilisation | - Median LoS 8 days - No patient education, no standard protocol for oral analgesia, conventional anaesthesia and sedation, no prevention of postoperative nausea and vomiting, mobilisation 1-day post-surgery | 1 month |
 Savaridas et al. 2013 [34] | United Kingdom | THR (42) TKR (58) | Short-stay: 1,500 Usual care: 3,000 | Short-stay: 53 Usual care: 51 | Short-stay: 68 Usual care: 69 | - Length of stay not reported - Targeted patient and staff education, low-dose spinal anaesthesia, tranexamic acid, local anaesthetic, early mobilisation, functional discharge criteria | - Length of stay not reported - Generic patient and staff education, general anaesthesia, catheterisation, mobilisation 1-day post-surgery, patient-controlled analgesia | 3 months |
 Stambough et al. 2015 [41] | United States | THR | Short-stay: 488 Usual care: 281 | Short-stay: 49 Usual care: 55 | Short-stay: 55 [45-64] Usual care: 59 [51-67] | - Median LoS 2 days - Five targets of patient education (mandatory), pain (intra-op, no opioids), mobilisation (early mobilisation), anaesthesia (patient-specific spinal), and nursing (staff coordination) | - Median LoS 4 days - No patient education, patient-controlled analgesia, mobilisation delayed, general anaesthesia, and nursing not integrated into postoperative care | 30 days |
 Starks et al. 2014 [35] | England | THR (41) TKR (59) | Short-stay: 2,128 Usual care: 2,065 | Short-stay: 65 Usual care: 66 | Mean [range] Short-stay: 71 [28–93] Usual care: 72 [26–98] | - Median LoS TKR 4 days - Median LoS THR 4 days - Patient education, spinal anaesthetic, normothermia, standardised analgesic ladder, and early mobilisation | - Median LoS TKR 6 days - Median LoS THR 6 days - Usual care pathway not reported | 30 days |
 Stowers et al. 2016 [63] | New Zealand | THR (31) TKR (69) | Short-stay: 100 Usual care: 100 | Short-stay: 53 Usual care: 59 | Short-stay: 67 (9) Usual care: 65 (13) | - Mean LoS 4 days - Short-stay pathway details located in supplementary material are no longer accessible | - Mean LoS 5 days - Usual care pathway details located in supplementary material are no longer accessible | 30 days |
 Tasso et al. 2022 [54] | Italy | THR (69) TKR (31) | Short-stay: 2,806 Usual care: 2,236 | Short-stay: 57 Usual care: 56 | Short-stay: 69 (7) Usual care: 67 (8) | - Mean LoS 5.1 days - Pre-admission evaluation, hospital admission, surgical strategies, anaesthesia, blood management, and early mobilisation | - Mean LoS 10.4 days - Usual care pathway not reported | 30 days |
 Taylor et al. 2022 [42] | United States | THR (33) TKR (31) | Short-stay: 279 Usual care: 294 | Short-stay: 67 Usual care: 66 | Short-stay: 61 (10) Usual care: 61 (10) | - Mean LoS 1.6 days - Patient education, anaesthesia regimen and surgical protocol, early mobilisation, and multimodal pain control | - Mean LoS 3.0 days - Usual care pathway not reported | 90 days |
 Teeny et al. 2005 [43] | United States | TKR | Short-stay: 55 Usual care: 55 | Short-stay: 69 Usual care: 71 | Mean [range] Short-stay: 70 [42–86] Usual care: 69 [41–84] | - Mean LoS 4.4 days - Intravenous fluids discontinued 1-day postop, catheters in place for a maximum of 24 h, early mobilisation | - Mean LoS 5.7 days - Intravenous fluids discontinued 2 days postop, catheters in place for up to 48 h, mobilisation the day after surgery | 3 months |
 Yanik et al. 2018 [44] | United States | THR (30) TKR (70) | Short-stay: 78 Usual care: 174 | Short-stay: 10 Usual care: 10 | Short-stay: 66 (9) Usual care: 66 (9) | - Mean LoS 1.7 days - Patient education, spinal anaesthesia without femoral nerve blocks, multimodal pain techniques, and early mobilisation | - Mean LoS 3.2 days - Usual care pathway not reported | 90 days |
Other observational study designs | ||||||||
 Castorina et al. 2017 [52] Retrospective observational study | Italy | TKR | Short-stay: 95 Usual care: 37 | Not reported | Short-stay: 71 (7) Usual care: 74 (6) | - LoS not reported - No tourniquet used, tranexamic acid used at 3-time points, no articular drainage | - LoS not reported - Regular articular drainage was used, tranexamic acid was only used at two time points | 2 months |
 Edelmann et al. 2022 [73]  Retrospective observational study | Switzerland | THR (62) TKR (38) | Short-stay: 302 Usual care: 138 | Short-stay THR: 51 Usual care THR: 42 Short-stay and usual care TKR: 64 | Short-stay THR: 61 (11) Usual care THR: 67 (11) Short-stay TKR: 64 (11) Usual care TKR: 67 (9) | - Mean LoS TKR 6.0 days - Mean LoS THR 5.3 days - Preoperative education and counselling, preoperative physiotherapy, local anaesthetic for infiltration and nerve blocks, perioperative oral analgesia, early mobilisation, continuous audit and improvement | - Mean LoS TKR 8.4 days - Mean LoS THR 7.7 days - No patient education, no preoperative physiotherapy, no local anaesthetic, no oral analgesia, no early mobilisation, no continuous improvement and audit | 90 days |
 Jiang et al. 2022 [46] Non-randomised prospective controlled study | China | TKR | Short-stay: 106 Usual care: 142 | Short-stay: 55 Usual care: 59 | Short-stay: 74 (6) Usual care: 75 (6) | - Mean LoS 9.6 days - Preoperative, intraoperative, and postoperative interventions with a focus on patient education, preoperative analgesia, and fasting guidelines | - Mean LoS 11.3 days - General anaesthetic, no multimodal analgesia, no blood protocol, mobilisation 1-day post-surgery | 5 days |
 Liao et al. 2022 [47] Non-randomised controlled study (retrospective allocation to control and intervention groups | China | TKR | Short-stay: 40 Usual care: 40 | Short-stay: 60 Usual care: 55 | Short-stay: 65 (5) Usual care: 65 (5) | - Length of stay not reported - General anaesthetic, operation room temperature adjusted to a lower temperature, all fluids headed to a specific temperature, body temperature monitored, thermal mattress used | - LoS not reported - No special heat preservation method was adopted during the surgery | 3 months |
 Reinhard et al. 2023 [68] Retrospective matched pair analysis | Germany | THR | Short-stay: 315 Usual care: 315 | Short-stay: 43 Usual care: 43 | Short-stay: 65 [20] Usual care: 65 [20] | - Length of stay not reported - Local infiltration analgesia, patient education, gain training, tranexamic acid, local infiltration analgesia, early mobilisation | - Length of stay not reported - No gait training or analgesic medication before surgery, long-lasting spinal anaesthesia, no tranexamic acid, drains applied | 24 h |
 Ripolles-Melchor et al. 2019 [72] Non-randomised prospective controlled study (allocated to control and intervention groups based on hospital) | Spain | THR (37) TKR (63) | Short-stay: 1592 Usual care: 4554 | Short-stay: 58 Usual care: 58 | Short-stay: 70 [63–76] Usual care: 71 [64–76] | - Median LoS 4 days - Sixteen Enhanced Recovery After Surgery Components based on Soffin & YaDeau’s recommendations | - Mean LoS 5 days - Usual care pathway not defined; individual patients were allocated to intervention or control groups based on the hospital’s short-stay protocols | 30 days |
 Scott et al. 2012 [36] Consecutive snapshot audits from all 22 orthopaedic units in Scotland | Scotland | THR (52) TKR (48) | Short-stay: 405 Usual care: 873 | Not reported | Short-stay: 68 (11) Usual care: 68 (10) | - Median LoS 4 days - Optimisation of pre-existing conditions, patient education, non-opioid multimodal analgesia, early mobilisation, and functional discharge | - Median LoS 5 days - Usual care pathway not reported | 12 weeks |
 Slim et al. 2022 [51] Non-randomised matched groups (retrospective allocation to control and intervention groups) | France | THR TKR | Short-stay: 21,081 Usual care: 21,081 | Not reported | Not reported | - LoS not reported - Short-stay pathway not described, but episodes of short-stay care were coded for inclusion in the study | - LoS not reported - Usual care pathway not reported | 90 days |
 Wang et al. 2023 [48] | China | THR | Short-stay: 45 Usual care: 45 | Short-stay: 71 Usual care: 56 | Short-stay: 66 (9) Usual care: 74 (12) | - Mean LoS 14 days - Preoperative optimisation, patient education, preoperative nutrition, multimodal pain relief, controlling body temperature, and early mobilisation | - Mean LoS 16 days - No protocol for pre-operative management | 3 days |