Supporting earlier discharge: How this hospital is improving surgical recovery for patients

Just 18 hours after stepping into Gleneagles Hospital for his total knee replacement surgery, Michael (not his real name) was discharged – and he was able to walk out the doors on his own, unassisted.

This rapid return to mobility was by design, not chance.

The 66-year-old private hire driver had spent the week before his operation preparing for it: doing exercises to build strength in the muscles around his knee, adjusting his nutrition and hydration, and learning what recovery would involve.

In a total knee replacement, the damaged surfaces of the knee joint are replaced with an artificial implant to eliminate bone-on-bone friction and relieve pain.

A few hours after his surgery at 8am, Michael was already in his first physiotherapy session. By the next morning, he was ready to go home, with further home-based physiotherapy planned to support his progress. 

Within two weeks, Michael regained full mobility. He returned to work within a month. Today, less than a year after his total knee replacement, he has no more pain in his left knee and has completely recovered.

Better preparation, faster recovery

What Michael experienced is the result of a structured approach called Enhanced Recovery After Surgery (ERAS), which Gleneagles Hospital implemented in 2025.

Initially used for total knee replacement surgeries, the programme is now applied to total hip replacements and selected procedures in other specialties.

The principle behind ERAS is simple: the better prepared a patient is before surgery, and the more coordinated their care during and after it, the faster and more safely they recover.

The programme brings together orthopaedic surgeons, anaesthetists, nurses, physiotherapists and dietitians around a shared recovery plan – one that starts before the patient even enters the operating theatre.

According to Gleneagles Hospital, the previous average length of hospital stay for total knee replacement surgery was four days. After introducing ERAS, the average length of stay now has been reduced to around two days.

Applying ERAS protocols in cardiothoracic (heart and lung) surgeries has been shown to shorten hospital stays and help patients become mobile sooner, which can help reduce the risk of post-operative complications.

“By integrating enhanced recovery principles with robotic surgical techniques, we’re often able to discharge patients the following day, with minimal pain and rapid mobilisation,” says Dr Harish Mithiran, a cardiothoracic surgeon at Gleneagles Hospital. “Traditional open surgery typically requires around five days in hospital.”

Adds Dr Kelvin Tan, the orthopaedic surgeon who treated Michael: “ERAS isn’t just about sending patients home sooner. It’s about making sure they’re genuinely ready to go – and that the care they receive is coordinated every step of the way.”

Less invasive techniques to aid surgical recovery

Enhancing patient recovery goes beyond ERAS. Innovations, including using a non-traditional direct anterior approach for total hip replacements, also play an important role.

This method involves accessing the joint from the front of the hip through a small incision, passing between the muscles instead of cutting or detaching major muscles in traditional surgery, explains Dr Jerry Chen, orthopaedic surgeon at Gleneagles Hospital.

By keeping these muscles intact, patients are often able to discontinue the use of walking aids sooner; and take more steps just two weeks after surgery, he notes.

Dr Chen adds: “As a result, many patients experience improvements in quality of life and are able to return to sports and recreational activities, including golf and racket games.”

For younger patients with knee degeneration, Gleneagles Hospital also offers knee preservation surgery, which could possibly delay or avoid the need for total knee replacement down the road.

This can involve realignment of the joint, repairing cartilage or ligaments, and treatments to improve shock absorption and joint mechanics.

Expanding day surgery procedures

Alongside enhanced recovery protocols and innovative surgical techniques, Gleneagles Hospital has been expanding its range of day surgery procedures, allowing suitable patients to come in for surgery, and return home the same day.

Gallbladder removal and hysterectomy – both traditionally associated with multi-day hospital stays – are increasingly being performed as day procedures using keyhole techniques, which leave smaller scars and cause less post-operative pain.

Shorter stays also have wider benefits: each bed freed is available for another patient, reducing ward pressure and lowering costs for patients.

New hybrid operating theatre

A new hybrid operating theatre opened in March to support minimally invasive surgery, combining advanced real-time imaging with surgical tools to reduce trauma and support faster recovery.

“The hybrid operating theatre will enhance our capabilities, particularly for complex heart and vascular conditions,” says Mr Thomas Wee, chief executive of Gleneagles Hospital.

“With an ageing population across Singapore and the region, we’re seeing more patients with complex conditions requiring specialised care,” he adds. “We’ve made real progress, but this is a long journey, and we’ll keep learning from best practices locally and internationally.”

Learn how ERAS supports recovery for total knee replacement patients at Gleneagles Hospital.