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Background As Enhanced Recovery After Surgery (ERASÒ) programs expand across numerous subspecialties, growth and sustainability on a system level becomes increasingly important and may benefit from reporting multidisciplinary and financial data. However, the literature on multidisciplinary outcome analysis in ERAS is sparse. This study aims to demonstrate the impact of multidisciplinary ERAS auditing in a hospital system. Additionally, we describe developing a financial metric for use in gaining support for system-wide ERAS adoption and sustainability. Methods Data from HPB, colorectal and urology ERAS programs at a single institution were analyzed from a prospective ERAS Interactive Audit System (EIAS) database from September 2015 to June 2019. Clinical 30-day outcomes for the ERAS cohort (n = 1374) were compared to the EIAS pre-ERAS control (n = 311). Association between improved ERAS compliance and improved outcomes were also assessed for the ERAS cohort. The potential multidisciplinary financial impact was estimated from hospital bed charges. Results Multidisciplinary auditing demonstrated a significant reduction in postoperative length of stay (LOS) (1.5 days, p \ 0.001) for ERAS patients in aggregate and improved ERAS compliance was associated with reduced LOS (coefficient -0.04, p = 0.004). Improved ERAS compliance in aggregate also significantly associated with improved 30-day survival (odds ratio 1.04, p = 0.001). Multidisciplinary analysis also demonstrated a potential financial impact of 44% savings (p \ 0.001) by reducing hospital bed charges across all specialties. Conclusions Multidisciplinary auditing of ERAS programs may improve ERAS program support and expansion. Analysis across subspecialties demonstrated associations between improved ERAS compliance and postoperative LOS as well as 30-day survival, and further suggested a substantial combined financial impact.

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Patient-reported outcomes (PROs) are essential for patient-centered health care. This pilot study implemented a mobile application customized to an hepatopancreatobiliary Enhanced Recovery After Surgery (ERAS®) program—a novel environment—for real-time collection of PROs, including ERAS® pathway compliance. Patients undergoing hepatectomy, distal pancreatectomy, or pancreaticoduodenectomy through the ERAS® program were prospectively enrolled over 10 months. The application provided education and questionnaires before surgery through 30 days postdischarge. Thresholds were set for initial adoption of the application (75%), PRO response rate (50%), and patient satisfaction (75%). Daily postdischarge health checks integrated customized responses to guide out-of-hospital care. Of 165 enrolled patients, 122 met inclusion criteria. Application adoption was 93 per cent (114/122) and in-hospital engagement remained high at 88 per cent (107/122). Patients completed 62 per cent of PRO on quality of life, postoperative pain, nausea, opioid consumption, and compliance to ERAS® pathway items, including ambulation and breathing exercises. During postcharge tracking, 12 patients reported that the application prevented a phone call to the hospital and three patients reported prevention of an emergency room visit. PRO collection through this mobile device created an integrated platform for comprehensive perioperative care, patient-initiated outcome tracking with automatic reporting, and real-time feedback for process change. Improving proactive outpatient management of complex patients through mobile technology could help restructure health-care delivery and improve resource utilization for all patients.

ndometrial cancer is the most common cancer of the female reproductive system in the United States and developed world. 1,2 The American Cancer Society estimates 65,950 new cases of uterine cancer (endometrial cancers and uterine sarcomas) in 2022. 1 This is an increase of 6.6% from 2019. 3 Risk factors for endometrial cancer include advancing age, early menarche, nulliparity, late menopause, hormone replacement therapy, obesity, type 2 diabetes, polycystic ovarian syndrome, and genetic disorders such as Lynch syndrome. 4 The average age of diagnosis is 60 years. 1 The most common clinical presentation of a woman with endometrial cancer is abnormal postmenopausal vaginal bleeding. 4 Physical examination fi ndings are limited, because peritoneal abnormalities and adnexal masses are more indicative of advanced disease. 4 At the time this article was written, Lacey King was a student in the