Optimization of perioperative nutrition management based on the ERAS protocol for improving postoperative recovery in patients undergoing total knee arthroplasty: a prospective comparative study

Abstract

Objective To investigate the clinical effects of an ERAS-based perioperative nutrition management bundle on nutritional status (indicated by prealbumin), postoperative complications (postoperative nausea and vomiting, PONV), and patient satisfaction in patients undergoing total knee arthroplasty (TKA), and to provide preliminary evidence for the standardization of ERAS nutrition protocols in orthopedic practice. Methods A total of 96 patients scheduled for TKA between January 2025 and December 2025 were allocated into two groups (control group, n = 48; nutrition group, n = 48) using an alternating assignment method based on admission order (quasi-randomization). The control group received traditional fasting regimens, while the nutrition group implemented an ERAS-optimized protocol. The primary outcome was prealbumin (PA) level on postoperative day 3; secondary outcomes included ESR, PONV, patient satisfaction, and fasting times. Results The nutrition group had significantly shorter fluid fasting time (2.08 ± 0.28 vs. 7.23 ± 3.72 h, P < 0.001). On postoperative day 1, the nutrition group showed lower ESR (11.51 ± 8.89 vs. 15.79 ± 11.41 mm/h, P = 0.043) and higher PA (199.67 ± 46.98 vs. 177.48 ± 35.32 mg/L, P = 0.011); on day 3, PA remained significantly higher (139.29 ± 37.13 vs. 125.31 ± 26.62 mg/L, P = 0.037). The incidence of PONV was lower in the nutrition group (4.17% vs. 18.75%, P = 0.025), with higher patient satisfaction (P = 0.012). A simplified multivariable logistic regression model adjusting for age confirmed the independent association between the nutrition intervention and reduced PONV (OR = 0.19, 95%CI 0.04–0.95, P = 0.043). No significant differences were observed in total blood loss, drain output, or length of hospital stay (all P > 0.05). Conclusion In this prospective comparative study, an ERAS-based perioperative nutrition protocol was associated with shorter fluid fasting time, better preservation of early postoperative prealbumin levels, a lower incidence of PONV, and higher patient satisfaction compared with traditional fasting, without increasing perioperative blood loss or prolonging hospital stay. These findings support the safety and feasibility of this protocol; however, due to the quasi-randomized design and exploratory nature of the secondary analyses, these associations should be interpreted with caution. They require confirmation in larger, randomized trials with longer follow-up and functional outcome assessment.