Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution

Abstract

Background As Enhanced Recovery After Surgery (ERASÒ) programs expand across numerous subspecialties, growth and sustainability on a system level becomes increasingly important and may benefit from reporting multidisciplinary and financial data. However, the literature on multidisciplinary outcome analysis in ERAS is sparse. This study aims to demonstrate the impact of multidisciplinary ERAS auditing in a hospital system. Additionally, we describe developing a financial metric for use in gaining support for system-wide ERAS adoption and sustainability. Methods Data from HPB, colorectal and urology ERAS programs at a single institution were analyzed from a prospective ERAS Interactive Audit System (EIAS) database from September 2015 to June 2019. Clinical 30-day outcomes for the ERAS cohort (n = 1374) were compared to the EIAS pre-ERAS control (n = 311). Association between improved ERAS compliance and improved outcomes were also assessed for the ERAS cohort. The potential multidisciplinary financial impact was estimated from hospital bed charges. Results Multidisciplinary auditing demonstrated a significant reduction in postoperative length of stay (LOS) (1.5 days, p \ 0.001) for ERAS patients in aggregate and improved ERAS compliance was associated with reduced LOS (coefficient -0.04, p = 0.004). Improved ERAS compliance in aggregate also significantly associated with improved 30-day survival (odds ratio 1.04, p = 0.001). Multidisciplinary analysis also demonstrated a potential financial impact of 44% savings (p \ 0.001) by reducing hospital bed charges across all specialties. Conclusions Multidisciplinary auditing of ERAS programs may improve ERAS program support and expansion. Analysis across subspecialties demonstrated associations between improved ERAS compliance and postoperative LOS as well as 30-day survival, and further suggested a substantial combined financial impact.

Validation of the Enhanced Recovery after Surgery (ERAS) society recommendations for liver surgery: a prospective, observational study

“…Adherence is one of the key factors for the successful implementation of an ERAS protocol. Detailed adherence data for the ERAS Guidelines for Liver Surgery do not exist to date and this study is therefore the first study to report on the adherence for each perioperative phase and specific ERAS item ( 2 , 8 , 22 , 23 ). Individual items of the guidelines have been validated whether they are suitable for liver surgery.…”

“…When at risk for PONV (Apfel score 2 ≥2), multimodal PONV prophylaxis (drug and nondrug) was administered with an adherence of 81.3% (ERAS-Item 15). The volume of crystalloid and colloid infusions and of blood products, as well as central venous pressure (CVP) immediately before parenchymal transection, was recorded (ERAS- Items 19,21,22,23). A CVP below 5 could be achieved in only 56% of ERAS patients.…”

Significant financial differences of chemical and surgical androgen deprivation in a contemporary cohort

“…This methodology is consistent with prior works in this space, which allows comparison of this contemporary cohort and the historical literature ( 10 ). Charges have also been used for comparing treatment arms in more recent publications ( 33 - 35 ). The surgical castration cohort is a small sample size in relation to the chemical ADT group, but the proportion of surgical patients (5% of total) was actually slightly more than what has been reported for population surgical castration utilization ( 4 ).…”

Enhanced Recovery After Surgery: An Orthopedic Perspective

“…Furthermore, the publication of helpful tools such as the Reporting on ERAS Compliance, Outcomes, and Elements Research (RECoVER) checklist [43] has made the accurate reporting of ERAS interventions easier. Advancements in continuous audit tools such as the ERAS Interactive Audit System benefit compliance, clinical outcomes, and costeffectiveness [44] while facilitating the proper auditing and response to ERAS interventions; their development should also expand to include orthopedic surgery. Future integration of the electronic health record and development of livestreamed variance points will further aid pathway compliance.…”