ERAS, length of stay and private insurance: a retrospective study

Celio, Diana; Poggi, Roberto; Schmalzbauer, Mike; Rosso, Raffaele; Majno, Pietro; Christoforidis, Dimitri

doi:10.1007/s00384-019-03391-2

Cited by 9 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, not all studies reported the reasons for failure of SDD amongst patients included within SDD pathways. This may be relevant as discharge delays can often be due to social or non-medical reasons, clinician or patient preferences, as well as private insurance requirements [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Zheng

Wee

Abdullah

et al. 2023

Int J Colorectal Dis

View full text Add to dashboard Cite

Background Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or “hyper-ERAS”, is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery. Methods The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool. Results Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort. Conclusion SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Zheng

Wee

Abdullah

et al. 2023

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…7 Several analyses acknowledge the confounded nature of LOS, often affected by a multitude of social factors and the distance a patient has traveled for care, and therefore, we decided this was not a reliable primary end point. 32,33 Presumably, the touted benefit of reduced LOS by the robotic approach was the consequence of less early postoperative pain. Therefore, this was chosen as the more salient variable off of which to power the analysis, and a 30% reduction has been consistently defined elsewhere as a minimal clinically important difference.…”

Section: Discussionmentioning

confidence: 99%

“…There, the longer operative time for robotic repairs (46% vs 30% > 2 hours; P < .001) was countered by a shorter median LOS (0 vs 1 day; interquartile range, 3.00; P < .001), lower rate of seroma (4% vs 9%; P = .02), and fewer overall complications (8% vs 19%; P < .001) . Several analyses acknowledge the confounded nature of LOS, often affected by a multitude of social factors and the distance a patient has traveled for care, and therefore, we decided this was not a reliable primary end point . Presumably, the touted benefit of reduced LOS by the robotic approach was the consequence of less early postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Despite rapid adoption of the robotic platform for ventral hernia repair with intraperitoneal mesh in the United States, there is no level I evidence comparing it with the traditional laparoscopic approach. This randomized clinical trial sought to demonstrate a clinical benefit to the robotic approach.OBJECTIVE To determine whether robotic approach to ventral hernia repair with intraperitoneal mesh would result in less postoperative pain. DESIGN, SETTING, AND PARTICIPANTSA registry-based, single-blinded, prospective randomized clinical trial at the Cleveland Clinic Center for Abdominal Core Health, Cleveland, Ohio, completed between September 2017 and January 2020, with a minimum follow-up duration of 30 days. Two surgeons at 1 academic tertiary care hospital. Patients with primary or incisional midline ventral hernias of an anticipated width of 7 cm or less presenting in the elective setting and able to tolerate a minimally invasive repair.INTERVENTIONS Patients were randomized to a standardized laparoscopic or robotic ventral hernia repair with fascial closure and intraperitoneal mesh. MAIN OUTCOMES AND MEASURESThe trial was powered to detect a 30% difference in the Numerical Rating Scale (NRS-11) on the first postoperative day. Secondary end points included the Patient-Reported Outcomes Measurement Information System Pain Intensity short form (3a), hernia-specific quality of life, operative time, wound morbidity, recurrence, length of stay, and cost. RESULTSSeventy-five patients completed their minimally invasive hernia repair: 36 laparoscopic and 39 robotic. Baseline demographics and hernia characteristics were comparable. Robotic operations had a longer median operative time (146 vs 94 minutes; P < .001). There were 2 visceral injuries in each cohort but no full-thickness enterotomies or unplanned reoperations. There were no significant differences in NRS-11 scores preoperatively or on postoperative days 0, 1, 7, or 30. Specifically, median NRS-11 scores on the first postoperative day were the same (5 vs 5; P = .61). Likewise, postoperative Patient-Reported Outcomes Measurement Information System 3a and hernia-specific quality-of-life scores, as well as length of stay and complication rates, were similar. The robotic platform adds cost (total cost ratio, 1.13 vs 0.97; P = .03), driven by the cost of additional operating room time (1.25 vs 0.85; P < .001).CONCLUSIONS AND RELEVANCE Laparoscopic and robotic ventral hernia repair with intraperitoneal mesh have comparable outcomes. The increased operative time and proportional cost of the robotic approach are not offset by a measurable clinical benefit.

show abstract

“…27 While placement issues are rarely problematic for patients in private hospitals, 28 a possible explanation for the difference in LOS between general ward and private ward patients, where the cost difference is on average 5 times higher, is that patients with better socio-economic backgrounds may have higher expectations for surgical outcomes 29 ; thus, they may tolerate longer hospital stays for rehabilitation, despite the higher costs of such stays. Private insurance is also reportedly an independent predictor of discharge delay despite objective readiness for discharge 30 ; however, we presumed that the effect of insurance was not applicable in the present study because fewer than 10% of patients in our cohort had no insurance coverage. Furthermore, no significant differences in the mean LOS were noted with regard to the nature of surgery, sex, or age in the ERAS group.…”

Section: Discussionmentioning

confidence: 76%

Effects of enhanced recovery after surgery practices on postoperative recovery and length of stay after unilateral primary total hip or knee arthroplasty in a private hospital

Chung

Ng³

et al. 2021

Hong Kong Med J

View full text Add to dashboard Cite

Introduction: Enhanced recovery after surgery (ERAS) practices improve postoperative recovery and reduce postoperative length of stay (LOS) in patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our study investigated whether these promising results could be reproduced in a private hospital setting. Methods:In total, 228 patients were included in the study cohort: the conventional group comprised 117 patients from 2012 to 2014, while the ERAS group comprised 111 patients from 2017 to 2018. All patients had undergone unilateral primary THA or TKA at a private hospital in Hong Kong. The outcome was postoperative LOS; factors affecting LOS were also investigated.Results: No significant differences were found in any baseline parameters between the two groups of patients. The mean LOS was significantly shorter in the ERAS group than in the conventional group (3.28 ± 1.04 vs 5.16 ± 2.06 days, P<0.001). Moreover, a significantly greater proportion of patients could be discharged on or before postoperative day 3 in the ERAS group, compared with the conventional group (77.5% vs 13.7%, P<0.

show abstract

ERAS, length of stay and private insurance: a retrospective study

Cited by 9 publications

References 29 publications

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

Effects of enhanced recovery after surgery practices on postoperative recovery and length of stay after unilateral primary total hip or knee arthroplasty in a private hospital

Contact Info

Product

Resources

About