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

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.