Determining the Safety and Efficacy of Enhanced Recovery Protocols in Major Oncologic Surgery: An Institutional NSQIP Analysis

Abstract

Background: Enhanced recovery (ER) protocols are increasingly being utilized in surgical practice. Outside of colorectal surgery, however, their feasibility, safety, and efficacy in major oncologic surgery have not been proven. This study compared patient outcomes before and after multispecialty implementation of ER protocols at a large comprehensive cancer center.Methods: Surgical cases performed from 2011-2016 and captured by an institutional NSQIP database were reviewed. Following exclusion of outpatient and emergent surgeries, 2747 cases were included in the analyses. Cases were stratified by presence or absence of ER compliance, defined by preoperative patient education and electronic medical record order set-driven opioidsparing analgesia, goal-directed fluid therapy, and early postoperative diet advancement and ambulation.

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

“…The implementation of enhanced recovery programs has improved perioperative outcomes after oncologic surgery. 43 Our study emphasizes the importance of extending ERAS principles beyond discharge, which requires both education and compliance. Compliance measures need to be in place in order to measure outcomes accurately that are associated with ERAS implementation.…”

Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay

“…Currently, enhanced recovery pathways are an advantageous contemporary perioperative care model for hepatectomy patients with benefits that include reduced LOS, decreased morbidity, decreased opioid use, and earlier recovery to baseline [ [3] , [4] , [5] , 23 , 24 ]. However, enhanced recovery pathways are often singular for all patients regardless of operative complexity.…”

“…Safety and quality of liver surgery have improved greatly despite its inherent risk and complexity [ 1 , 2 ]. Enhanced recovery protocols have played a significant role in standardizing perioperative care resulting in decreased length of stay (LOS), complications, and opioid use and improved patient function [ [3] , [4] , [5] ]. Taking surgical complexity (beyond major versus minor hepatectomy) into account may further refine enhanced recovery pathways by allowing for more effective stratification of risk and thus more specific and effective patient education and engagement.…”

Comparison of Liposomal Bupivacaine to a Local Analgesic Cocktail for Transversus Abdominis Plane Blocks in Abdominally Based Microvascular Breast Reconstruction

“…20 Multimodal analgesia has been shown to be a safe, effective, and reproducible way to decrease opioid use in the perioperative setting. [21][22][23][24][25][26][27][28] Along with improved patient outcomes, ERAS protocols present an opportunity for significant cost savings. Ljungqvist et al found that ERAS implementation resulted in a 30 to 50 percent shorter hospital length of stay, while reducing complications, readmissions, and costs.…”