D. M. Jomaa1, H. Wasvary1,2 1Oakland University William Beaumont School Of Medicine,Department Of Colorectal Surgery,Royal Oak, MI, USA 2Beaumont Health System Research Institute,Department Of Colorectal Surgery,Royal Oak, MI, USA
Introduction: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary program that incorporates best practice guidelines into the perioperative process. Previous studies show adherence to ERAS protocols improve outcomes with respect to hospital stays, complication rates and patient satisfaction. In August 2015, the Department of Colon and Rectal Surgery implemented an ERAS program at Beaumont Hospital, Royal Oak at the same time the department introduced minimally invasive robotic procedures into their curriculum. Both processes were felt to be important in improving outcomes following colorectal surgeries. The aim of our project was to look at how the implementation of an ERAS program impacted outcomes with respect to length of stay (LOS), and if the method of surgery had any impact on this outcome.
Methods: Elective colon and rectal procedures between June 2013 and June 2017 (n=654) were reviewed. Patients undergoing surgery prior to ERAS implementation were labeled Pre ERAS (n=102) and those after implementation were labeled Post ERAS (n=452). Charts were reviewed for patient demographics, ASA scores, LOS, BMI, wound class, surgical date and method of surgery. ERAS participants underwent a preoperative evaluation and were educated with regards diet, exercise and best practice processes. During surgery, ERAS patients were given medications to enhance bowel motility, and fluids and narcotics were guided by protocol. Postoperatively, early ambulation, early resumption of food and judicious use of narcotics was followed for the ERAS participants.
Results: No significant differences were noted between the Pre and Post ERAS groups with respect to age, BMI, ASA or gender. Significant differences existed when comparing the two groups for LOS with a median stay of 5 and 4 days for the Pre and Post ERAS groups, respectively (p<0.0001). The wound classification identified a significantly higher proportion of “contaminated” cases in the Post ERAS era (p<0.001). A higher percentage of robotic cases were done in the Post ERAS era (42%) compared to Pre ERAS (25%) (p<.001). All variables were measured against the outcome of LOS via regression analysis. A univariate analysis showed LOS was significantly reduced for younger, male patients with lower ASA scores and undergoing robotic surgery during the Post ERAS period. No significant differences existed for BMI or wound class. A multivariate analysis showed higher ASA scores (p=0.003) and female gender (p=0.05) independently predicted a longer LOS (p=0.003). ERAS independently predicted a shorter LOS (p<0.0001). Robotic procedures did not impact LOS when all variables were considered.
Conclusion: The inception of an ERAS program is an independent predictor for reduction in the LOS following surgical resection and this improvement was not influenced by the method of surgery. This data is important when rationalizing the need to put continued resources into the further development of best practice initiatives.