S. J. Baker1,2, C. Rentas1,2, E. Malone1,2, J. Richman1,2, E. Dasinger1,2, C. Key1,2, D. Chu1,2, M. Morris1,2 1University Of Alabama at Birmingham,General Surgery,Birmingham, Alabama, USA 2Birmingham Veterans Affairs Medical Center,General Surgery,Birmingham, ALABAMA, USA
Introduction: ERAS has been shown to decrease post-operative length of stay (LOS). However, little research has been done specifically in the geriatric patient population. Given that certain components of a standard ERAS pathway may be avoided in the geriatric population (for example medications like ketorolac), it is unknown if this would decrease the overall efficacy of the pathway. Despite this, we hypothesized that LOS would decrease following ERAS implementation for our older adult patients.
Methods: We conducted a cohort study between January 2012 and March 2018 for geriatric patients undergoing elective general surgery. All patients aged 65 and over who underwent an operation using the ERAS protocol between January 2016-March 2018 were identified as ERAS patients. CPT Codes identified pre-ERAS patients 65 and over who underwent similar operations from January 2012-January 2016. Demographic and procedural information was collected through Veterans Affairs Surgical Quality Improvement Program (VASQIP). Patients undergoing emergent surgery or who had an in-hospital mortality were excluded. Primary outcomes assessed included LOS and 30-day readmission rates. Patient demographics, surgery characteristics, and VASQIP defined complication rates were compared across groups (pre-ERAS vs ERAS) using Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests.
Results: Our entire cohort included 257 patients (177 pre-ERAS vs. 80 ERAS). The median age was 68 (IQR: 66-72), 94% were male (n=242), and 70% were Caucasian. There was no significant difference between the groups in age, race, or pre-operative functional status, and both groups underwent similar procedures (pre-ERAS vs ERAS; Age: 68 vs 69, p=0.36; Race (Caucasian): 73% vs 63%, p=0.55; Functional Status (Independent): 93% vs 86%, p=0.5). The ERAS patients had a significantly shorter median LOS at 5 days compared to the pre-ERAS group at 7 days (p<0.001). There was no difference in 30-day readmission rates (pre-ERAS 14% vs ERAS 15%, p=0.85) or overall complication rates (pre-ERAS 22% vs ERAS 24%, p=0.40).
Conclusion: Older adult patients benefit from ERAS implementation within the VA hospital. Further research needs to be focused on which ERAS elements may be safely eliminated in older adults while maintaining the length of stay and readmission benefits.
