Enhanced Recovery after Surgery (ERAS) Protocols Expanded over Multiple Service Lines Improves Patient Care and Hospital Cost

Abstract

Enhanced recovery after surgery (ERAS) may improve patients’ postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology – nephrectomy and cystectomy, spinal fusion, cardiac surgery—coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

“…Concept and institutional implementation of evidence-based Enhanced Recovery After Surgery (ERAS) clinical pathways aim to incorporate best practice and improve measurable clinical outcomes, including pain, mortality, hospital length of stay, patient satisfaction, and costs. [6][7][8][9] ERAS pathways have been published to guide the management of patients undergoing different surgery types, including colorectal, 10 gynecologic, 11 and thoracic surgeries. 12 Also, outside of published institutional protocols, 9,[13][14][15][16][17][18][19][20][21][22][23][24] the ERAS Society recently published evidence-based ERAS pathway recommendations for lumbar fusion.…”

Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynecologic Oncology: A Review

“…To address these concerns, most modern studies of ERAS implementation assess for readmission rate and many also look at complication rate following surgery. A total of 21 of the published ERAS intervention studies to date have reported on complications, with rates of complications prior to ERAS introduction ranging from 5% to 70%, depending on the population/surgery studied and the grade of complication reported [ 11 , 14 , 24 ]. The PROFAST study looked at specific complications between the ERAS and conventional management arms of the study and found no statistically significant difference in major (Grade IIIB-V) complications between the 2 arms, but noted a 10% reduction in postoperative ileus with ERAS interventions.…”

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

“…The principles of enhanced recovery, when fully implemented, have been demonstrated to reduce the length of hospital stay (LOS), morbidity, and convalescence, without an increase in readmission rates or complications [ 4 , 18 , 19 , 20 ]. Enhanced recovery pathways (ERP) can be considered a Quality Improvement (QI) intervention and are an inter-professional and multimodal approach to care [ 21 , 22 , 23 , 24 , 25 , 26 ]. ERP seeks to optimize patient care before, during, and after surgery to minimize the surgical stress response.…”