ERAS in a single high-volume surgical oncology unit

Patient Population
Mixed abdominal cancer surgery.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERAS).

Trial Design
Before vs after ERAS introduction.

Outcome Impact
LOS reduced by 2 days (8 to 6) & mortality reduced from 2.9% to 0%.

BACKGROUND
Benefits of ERAS protocol have been well documented; however, it is unclear whether the improvement stems from the protocol or shifts in expectations.

METHODS
Interdisciplinary educational seminars were conducted for all healthcare professionals. However, one test surgeon adopted the protocol.  394 patients undergoing elective abdominal surgery from June 2013 to April 2015 with a median age of 63 years were included.

RESULTS
The implementation of ERAS protocol resulted in a decrease in the length of stay (LOS) and mortality, whereas the difference in cost was found to be insignificant.  For the test surgeon, ERAS was associated with decreased LOS, cost, and mortality. For the control providers, the LOS, cost, mortality, readmission rates, and complications remained similar both before and after the implementation of ERAS.  Pre- and post-ERAS outcomes were studied for the test provider. Patients in both the groups were similar in gender, age, race, diagnosis, and comorbidities. Mean LOS was significantly decreased during the post-ERAS implementation phase (9.6 days pre-ERAS versus 6.2 days post-ERAS, p = 0.024). Costs were also significantly different ($21,674 versus $30,380; p = 0.029). The in-hospital mortality rate was also lower in the post-ERAS phase (0 versus 3.3%, p = 0.044). The increase in the number of pancreatectomies, major complications, and readmission rates failed to reach statistical significance.

CONCLUSION
An ERAS protocol on the single high-volume surgical unit decreased the cost, LOS, and mortality.

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