C. Mosquera1, N. J. Koutlas1, K. K. Myatt1, N. A. Vohra1, E. E. Zervos1, T. L. Fitzgerald1 1East Carolina University Brody School Of Medicine,Division Of Surgical Oncology,Greenville, NC, USA
Introduction: Benefits from ERAS have been documented in various clinical settings; however, it is unclear if improvement stems from the protocol or by shifts in expectations. To clarify, outcomes from a pilot ERAS project were reviewed.
Methods: Introductory interdisciplinary educational seminars involving unit surgeons, residents, nurses, dieticians, and rehabilitation therapists were conducted. In order to validate our initial test of change, this protocol was adopted by one of three surgical oncologists with the others serving as controls.
Results: A total of 394 patients undergoing elective abdominal surgery from June 2013-April 2015 were included. Median age was 63 years, a majority were female (51.8%), white (59.9%), had a Charlson comorbidity score of 0-2 (40.4%), and a Clavien complication grade of 0-I (63.2%). Implementation of ERAS resulted in a significant decrease in length of stay (LOS) (6.0 vs. 8.0 days; p= 0.016) and in-hospital mortality (0% vs. 2.9%; p= 0.033); the difference in cost ($21,674 vs. $25,994; p= 0.060) did not reach significance. Gender (p= 0.63), age (p= 0.36), race (p= 0.89), type of surgery (p= 0.49), comorbidities (p= 0.76), complications (p= 0.31), and readmission rates (p= 0.21) were similar. For the test surgeon, ERAS was associated with a decreased LOS (6.2 vs. 9.6 days, p= 0.024), cost ($21,674 vs. $30,380, p= 0.029), and mortality (0 vs. 3.3%, p= 0.044); differences in complications (grade II-V 32.2 vs. 42.6%, p= 0.064) and readmission rates (11.5 vs. 21.4%, p= 0.076) did not reach significance. For the control providers LOS, cost, mortality, readmission rates, and complications were similar before and after implementation of ERAS on this unit.
Conclusion: Full implementation of an ERAS protocol on a single high-volume surgical unit decreases cost, LOS, and mortality. This change can be attributed to protocol adherence rather than an ethereal change in unit culture.