D. N. Maurente1, A. Ardeljan1, A. Johns1, S. Willis1, H. Abdul1, M. Bustos1, S. Sennhauser1, M. Ghali1, A. Rashid1, M. Perez1, O. M. Rashid1 1Holy Cross Hospital,Michael And Dianne Bienes Comprehensive Cancer Center,Fort Lauderdale, FL, USA 2Massachusetts General Hospital,Boston, MA, USA 3University Of Miami Miller School Of Medicine,Miami, FL, USA 4Charles E. Schmidt College Of Medicine At Florida Atlantic University,Boca Raton, FL, USA
Introduction:
To improve postoperative length of stay (LOS) and readmissions (RA) in bowel surgery, enhanced recovery protocols (ERP) were developed promoting a multidisciplinary approach with minimal anesthesia, early ambulation and enteral alimentation, and multimodality analgesia. This study evaluated ERP at a community Hospital (HCH) for improved patient outcomes.
Methods:
Patient charts for DRG 329, 330, and 330 were retrospectively reviewed at HCH in 2017 to compare outcomes in ERP versus non-ERP cases. The Medicare claims database (CMS) was also retrospectively reviewed by the same DRG codes to determine LOS and RA. Standard statistical comparisons were used to determine significance.
Results:
At HCH: DRG 329 mean LOS for non ERP was 13.0833 days (n = 12) versus 3.375 (n = 8), p = < 0.001; DRG 330 mean LOS for non ERP was 10.861 days (n = 36) versus 4.583 (n = 24), p = < 0.001; and DRG 331 mean LOS for non ERP was 7.272 days (n = 11) versus 3.348 (n = 23), p = 0.004.
Based on comparable CMS data, HCH DRG 329 LOS improved from 90th to top 10th percentile (n = 238,907); DRG 330 from 90th to 28th percentile for DRG 330 (n = 285,423); and DRG 331 from 90th to 46th percentile for (n = 126,941), p < 0.001. HCH RA in ERP and non-ERP cases was 3% at 30 and 90 days. CMS RA for DRG 329 was 25.1% at 90 days and 9.9% at 30 days; DRG 330 RA was 18.3% at 90 days and 6.6% at 30 days; and DRG 331 RA was 11% at 90 days and 3.9% at 30 days.
Conclusion:
Implementation of ERP for bowel surgery at HCH improved outcomes, and future ERP research in non-bowel surgery is recommended.