ERAS | Single surgeon’s experience with enhanced recovery after surgery

Patient Population
Elective abdominal procedures.

LiDCO Monitor
LiDCOrapid.

Trial Design
A retrospective chart review performed to identify all patients who underwent elective abdominal surgery at one US medical centre, between June 2013 and April 2015. An ERAS pathway was implemented in June 2014. Three patient groups were categorised based on Charlson comobidity index (CCI).

Outcome Impact
Univariate analysis revealed that the ERAS protocol was associated with shorter LOS, lower cost, and lower mortality.

PURPOSE
This study sought to better understand the barriers and feasibility in designing an optimal perioperative, evidence-based pathway for a single surgeon performing a variety of complex abdominal procedures. This tertiary referral centre pilot studied the experience of a gastrointestinal surgical oncologist before and after the implementation of an ERAS protocol.

MATERIALS AND METHODS
The chart review included 179 patients who had undergone elective abdominal procedures from June 2013 to April 2015.

RESULTS
Primary outcomes were improved in the ERAS group. LOS was significantly shorter in the ERA patients compared to the non-ERAS patients (6.2 vs 9.6 days; P=0.024). Severity of complications was lower in the ERAS group. No mortality was reported within the ERAS group, whereas 3 patients died within the non-ERAS group (P=0.044). The mean cost of surgical-related hospital stay was significantly decreased in the ERAS group ($21,674 vs $30,380; P=0.029). Readmission rates were significantly lower in the ERAS group (11.5 vs 21.4%; P=0.029).

CONCLUSIONS
An ERAS program can be instituted by an individual surgeon with the benefits of decreased LOS, cost, and mortality.

Mosquera C, Koutlas NJ, Fitzgerald TL. A single surgeon’s experience with Enhanced Recovery after Surgery: An Army of One. Am Surg. 2016;82(7):594-601.

“In this series, we found that the ERAS significantly decreased readmission rates from 21.4 to 11.5 per cent. Our data did not include expenses associated with hospital readmission. Based on readmission-related cost studies, we predicted that our trend in readmission rates after ERAS protocol implementation will result in a significant decrease burden of health-care expense.”

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