The financial impact of an enhanced recovery after surgery (ERAS) protocol in an academic gynecologic oncology practice

Gentry, Zachary L.; Boitano, Teresa; Smith, Haller J.; Eads, D.; Russell, John F.; Straughn, J. Michael

doi:10.1016/j.ygyno.2019.11.017

Cited by 17 publications

(4 citation statements)

References 16 publications

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“…Most previous studies evaluating postoperative recovery have focused on physiological parameters such as LOS and morbidity [22,[31][32][33][34]. As the recovery process is complex and encompasses the multiple dimensions of physical [35], emotional and social health, patients' reported outcome are essential to evaluate the quality of recovery, measuring any aspect of a patient's health status with information derived directly from the patient.…”

Section: Discussionmentioning

confidence: 99%

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

Shen

Min

et al. 2021

BMC Anesthesiol

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Background Enhanced recovery after surgery (ERAS) pathways have been shown to improve clinical outcomes after surgery. Considering the importance of patient experience for patients with benign surgery, this study evaluated whether improved compliance with ERAS protocol modified for gynecological surgery which recommended by the ERAS Society is associated with better clinical outcomes and patient experience, and to determine the influence of compliance with each ERAS element on patients’ outcome after benign hysterectomy. Methods A prospective observational study was performed on the women who underwent hysterectomy between 2019 and 2020. A total of 475 women greater 18 years old were classified into three groups according to their per cent compliance with ERAS protocols: Group I: < 60% (148 cases); Group II:≥60 and < 80% (160 cases); Group III: ≥80% (167 cases). Primary outcome was the 30-day postoperative complications. Second outcomes included QoR-15 questionnaire scores, patient satisfaction on a scale from 1 to 7, and length of stay after operation. After multivariable binary logistic regression analyse, a nomogram model was established to predict the incidence of having a postoperative complication with individual ERAS element compliance. Results The study enrolled 585 patients, and 475 completed the follow-up assessment. Patients with compliance over 80% had a significant reduction in postoperative complications (20.4% vs 41.2% vs 38.1%, P < 0.001) and length of stay after surgery (4 vs 5 vs 4, P < 0.001). Increased compliance was also associated with higher patient satisfaction and QoR-15 scores (P < 0.001),. Among the five dimensions of the QoR-15, physical comfort (P < 0.05), physical independence (P < 0.05), and pain dimension (P < 0.05) were better in the higher compliance groups. Minimally invasive surgery (MIS) (P < 0.001), postoperative nausea and vomiting (PONV) prophylaxis (P < 0.001), early mobilization (P = 0.031), early oral nutrition (P = 0.012), and early removal of urinary drainage (P < 0.001) were significantly associated with less complications. Having a postoperative complication was better predicted by the proposed nomogram model with high AUC value (0.906) and sensitivity (0.948) in the cohort. Conclusions Improved compliance with the ERAS protocol was associated with improved recovery and better patient experience undergoing hysterectomy. MIS, PONV prophylaxis, early mobilization, early oral intake, and early removal of urinary drainage were of concern in reducing postoperative complications. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019178. Registered on 30/10/2018.

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Section: Discussionmentioning

confidence: 99%

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

Shen

Min

et al. 2021

BMC Anesthesiol

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“…Apart from clinical benefits, there are also significant health system benefits that can be achieved with the successful implementation of the Enhanced Recovery pathways: ERAS implementation in gynecologic oncology has been shown to create important healthcare cost savings. 15,32,[43][44][45] In the Canadian context, the net cost saving.s per patient was CAD$956. 15 In the American setting, savings ranged from US$2572 to US$7600 per patient, 20,32 and from a 15%…”

Section: Discussionmentioning

confidence: 99%

Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

Bernard

McGinnis

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The purpose of the study is to evaluate the impact of an enhanced recovery after surgery (ERAS) program implemented in a Gynecologic Oncology population undergoing a laparotomy at a Canadian tertiary care center. Material and methods Prospectively collected data, using the American College of Surgeons’ National Surgical Quality Improvement Program dataset (ACS NSQIP), was used to compare 30‐day postoperative outcomes of gynecologic oncology patients undergoing a laparotomy before and after the 2018 implementation of an ERAS program in a Canadian regional cancer center. Patient demographics, surgical variables and postoperative outcomes of 187 patients undergoing surgery in 2019 were compared with those of 441 patients undergoing surgery between January 2016 and December 2017. Student’s t, Mann‐Whitney U and Chi‐square tests, as well as multivariate linear and logistic regressions were used to evaluate baseline characteristics and 30‐day postoperative complications. Results Length of stay was significantly shortened in the study population after introducing the ERAS protocol, from a mean of 4.7 (SD = 3.8) days to a mean of 3.8 (SD = 3.2) days (P = .0001). The overall complication rate decreased from 24.3% to 16% (P = .02). Significant decreases in the rates of postoperative infections (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.31‐0.99) and cardiovascular complications (adjusted OR 0.27, 95% CI 0.09‐0.79) were noted, without a significant increase in readmission rate (adjusted OR 0.50, 95% CI 0.21‐1.07). Conclusions Introducing an ERAS program for gynecologic oncology patients undergoing laparotomy was effective in shortening length of stay and the overall complication rate without a significant increase in readmission. Advocacy for broader implementation of ERAS among gynecologic oncology services and ongoing discussion on challenges and opportunities in the implementation process are warranted to improve patient outcomes and experiences.

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“…Cost-benefit analysis was not within the scope of the current study but we note that recent data suggest peri-operative costs are unchanged with the use of enhanced recovery after surgery protocols. 25 The present study was completed in a pre-enhanced recovery protocol population; therefore, future cost effectiveness studies on combined enhanced recovery protocols and surgical site infection prevention bundles would be informative.…”

Section: Discussionmentioning

confidence: 99%

Dual antibiotic prevention bundle is associated with decreased surgical site infections

Kuznicki

Mallen

McClung

et al. 2020

Int J Gynecol Cancer

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BackgroundGynecologic oncology surgery is associated with a wide variation in surgical site infection risk. The optimal method for infection prevention in this heterogeneous population remains uncertain.Study DesignA retrospective cohort study was performed to compare surgical site infection rates for patients undergoing hysterectomy over a 1-year period surrounding the implementation of an institutional infection prevention bundle. The bundle comprised pre-operative, intra-operative, and post-operative interventions including a dual-agent antibiotic surgical prophylaxis with cefazolin and metronidazole. Cohorts consisted of patients undergoing surgery during the 6 months prior to this intervention (pre-bundle) versus those undergoing surgery during the 6 months following the intervention (post-bundle). Secondary outcomes included length of stay, readmission rates, compliance measures, and infection microbiology. Data were compared with pre-specified one-sided exact test, Chi-square test, Fisher’s exact test, or Kruskal–Wallis test as appropriate.ResultsA total of 358 patients were included (178 PRE, 180 POST). Median age was 58 (range 23–90) years. The post-bundle cohort had a 58% reduction in surgical site infection rate, 3.3% POST vs 7.9% PRE (−4.5%, 95% CI −9.3% to −0.2%, p=0.049) as well as reductions in organ space infection, 0.6% POST vs 4.5% PRE (−3.9%, 95% CI −7.2% to −0.7%, p=0.019), and readmission rates, 2.2% POST vs 6.7% PRE (−4.5%, 95% CI −8.7% to −0.2%, p=0.04). Gram-positive, Gram-negative, and anaerobic bacteria were all prevalent in surgical site infection cultures. There were no monomicrobial infections in post-cohort cultures (0% POST vs 58% PRE, p=0.04). No infections contained methicillin-resistant Staphylococcus aureus.ConclusionImplementation of a dual antibiotic infection prevention bundle was associated with a 58% reduction in surgical site infection rate after hysterectomy in a surgically diverse gynecologic oncology practice.

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The financial impact of an enhanced recovery after surgery (ERAS) protocol in an academic gynecologic oncology practice

Cited by 17 publications

References 16 publications

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

Dual antibiotic prevention bundle is associated with decreased surgical site infections

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