Impact of a colorectal enhanced recovery program implementation on clinical outcomes and institutional costs: A prospective cohort study with retrospective control

Portinari, Mattia; Ascanelli, Simona; Targa, Simone; Valgode, Elisabete Maria Dos Santos; Bonvento, Barbara; Vagnoni, Emidia; Camerani, Stefano; Verri, Marco; Volta, Carlo Alberto; Feo, Carlo V.

doi:10.1016/j.ijsu.2018.03.005

Cited by 17 publications

(18 citation statements)

References 19 publications

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“…There was an average 1458 Euros ($1655 USD) saved per colorectal surgery case when ERAS was performed. 18 Other institutions have shown ERAS spine surgery LOS was decreased by 1.5 to 2 days with no change in complication or readmission rate. The estimated potential cost savings from that study was $2.4 million.…”

Section: Discussionmentioning

confidence: 94%

Enhanced Recovery after Surgery (ERAS) Protocols Expanded over Multiple Service Lines Improves Patient Care and Hospital Cost

Heathcote

Duggan

Rosbrugh

et al. 2019

The American Surgeon™

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Enhanced recovery after surgery (ERAS) may improve patients’ postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology – nephrectomy and cystectomy, spinal fusion, cardiac surgery—coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.

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Section: Discussionmentioning

confidence: 94%

Enhanced Recovery after Surgery (ERAS) Protocols Expanded over Multiple Service Lines Improves Patient Care and Hospital Cost

Heathcote

Duggan

Rosbrugh

et al. 2019

The American Surgeon™

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“…From a nancial perspective, in this study, the ERAS Program reduced direct costs per patient. Several studies have shown that ERAS protocols were cost-effective (20,21,22). These cost studies also con rmed a decrease LOS in their cohorts.…”

Section: Discussionmentioning

confidence: 86%

Enhanced recovery after surgery (ERAS) protocol in Oblique lumbar interbody fusion(OLIF): a case-controlled study

Li¹,

Shao²,

Jiang³

2020

Preprint

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Abstract Background Enhanced recovery after surgery (ERAS) attempts to decrease the surgical stress response to minimize postoperative complications and improve functional rehabilitation after major surgery, but it have not been widely utilized in spinal surgery. This study is to evaluate the implementation of an ERAS pathway for patients undergoing oblique lumbar interbody fusion (OLIF) surgery.Methods This was a retrospective cohort study of patient who underwent OLIF in 2018 prior to ERAS (“pre-ERAS” ,n=23) and in 2019 after ERAS was instituted (“ERAS”, n=24). Major outcomes were collected included demographics, length of hospital stay, financial cost, postoperative complications, off-bed time and perioperative factors. Visual Analogue Scale (VAS) was used to evaluate the pain. The ERAS pathway and compliance with pathway elements were also recorded.Results After ERAS implementation, we found no significant differences in the baseline characteristics between the two groups. In our study, the mean stay in the hospital was significantly lower (p= 0.033) in the ERAS group (15.3±3.9 days) compared to the standard pathway group (13.0±3.1 days). In comparison to the standard group, we also found a variation between the financial costs of surgery and hospitalization [(16446.5±4353.3)vs(14237.7±2784.9) USD, P < 0.05]. The ERAS group manifested a lower blood loss compared with the pre-ERAS group with statistical significance [(68.3±57.1)vs(119.3±104.8) ml, P < 0.05]. There was no significant difference in operative time, complications, and 30-d readmission rates ( P > 0.05 ). Pain scores between the two groups showed a significant difference during the 3th hour and 6th hour (P < 0.05).Conclusion Institution of an ERAS protocol appears to accelerate functional recovery and reduce length of stay, financial costs and decreased pain.

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“…Certainly, perioperative care may well affect functional outcomes, post-operative length of hospital stay and morbidity. 26,27 In this study, however, similar evidence-based principles of perioperative care were implemented by a multidisciplinary group to enhance post-operative recovery at both institutions.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open transverse‐incision right hemicolectomy: a retrospective comparison study

Feo

Fancellu

et al. 2019

ANZ Journal of Surgery

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Background The optimal surgical approach to right colon cancer is still under debate. The aim of the present study was to compare the short‐ and long‐term outcomes of laparoscopic and transverse‐incision open approaches to right hemicolectomy for colon cancer. Methods Data on 99 adult patients with right‐side colon cancer undergoing either laparoscopic or open transverse‐incision right hemicolectomy at two different university hospitals, between January 2013 and December 2016, were retrospectively reviewed. Data concerning patients’ characteristics, operative details and post‐operative recovery were retrieved from prospective databases and analysed. Results Forty‐nine subjects were operated on laparoscopically, while 50 through an open transverse incision. Operating time was significantly longer in the laparoscopic group compared with the open group (182 versus 105 min; P < 0.01). Patients treated laparoscopically had a shorter time to first bowel movement, while time to resume a normal diet and post‐operative length of hospital stay were comparable in between groups. The median number of lymph nodes harvested was higher in the laparoscopic group (25.6 versus 18.6; P < 0.01), but no significant difference in overall survival between groups was detected. At long‐term follow‐up, the incidence of incisional hernia was higher in the laparoscopic group as compared to the open group (24.5% versus 0%; P = 0.0002). Conclusion Our results show that laparoscopic right hemicolectomy when compared to the transverse‐incision open procedure may guarantee the same oncological radicality, but short‐term functional benefits are still unclear. Randomized control studies are warranted to better clarify the comparison of these two approaches for right‐sided colon cancers.

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Impact of a colorectal enhanced recovery program implementation on clinical outcomes and institutional costs: A prospective cohort study with retrospective control

Abstract: Implementing a colorectal enhanced recovery program is feasible, efficient for functional recovery and hospital stay reduction, safe, and cost-effective. High patient satisfaction and nursing workload reduction may also be expected, but high protocol adherence is necessary.

Cited by 17 publications

References 19 publications

Enhanced Recovery after Surgery (ERAS) Protocols Expanded over Multiple Service Lines Improves Patient Care and Hospital Cost

Enhanced Recovery after Surgery (ERAS) Protocols Expanded over Multiple Service Lines Improves Patient Care and Hospital Cost

Enhanced recovery after surgery (ERAS) protocol in Oblique lumbar interbody fusion(OLIF): a case-controlled study

Laparoscopic versus open transverse‐incision right hemicolectomy: a retrospective comparison study

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