The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay

Abstract

Background Enhanced Recovery After Surgery (ERAS) is a multidisciplinary perioperative care program to optimize and enhance postoperative recovery. It has a beneficial role in decreasing the length of hospital stay and improving the quality of care. This study aims to observe the successful implementation of ERAS in reducing the length of hospital stay (LOS) among caesarean deliveries. Methods A pre-and post-implementation study of ERAS protocol was conducted, among cohort of women who underwent caesarean deliveries from January to December 2020 in the Department of Obstetrics and Gynaecology, Mongar Regional Referral hospital. Data collected retrospectively and analyzed in SPSS (IBM SPSS trial version); and comparison of length of hospital stay between the two groups were tested by t-test. Results One hundred seventy-one patients were included in the study: 87 in the pre-ERAS and 84 in the post-ERAS cohort. Post implementation, LOS decreased by an average of 21.0 (CI 16.11–24.64; p-value < 0.001) hours in the postoperative period. A greater proportion of patients were discharged on day-2 (2.3% in pre-ERAS and 81% in ERAS; p-value < 0.001). Conclusion Implementation of ERAS protocol can significantly decrease the postoperative length of hospital stay without increasing the complications and readmission rates.

A Scientometric Analysis and Visualization Discovery of Enhanced Recovery After Surgery

“…After 2015, patient-reported outcomes were the purpose of ERAS. More attention has been paid to the comfort and safety of patients in hospitals, as well as the reduction of surgical complications, rather than the reduction of hospital days and cost alone (44)(45)(46)(47).…”

Measuring enhanced recovery in obstetrics: a narrative review

“… 17 , 36 LOS remains the most popular outcome measure, most frequently reported in days. LOS was reduced in the ERAC group in most studies, 12 , 13 , 15 , 16 , 18 , 19 , 20 , 22 , 24 , 25 , 27 , 28 , 37 but unchanged in the rest. 14 , 17 , 21 , 23 , 29 Other process metrics include proportion of patients discharged on days 1 and 2, ERAC pathway compliance, and time to achieving interim clinical milestones such as first mobilization and urinary catheter removal.…”

“…The major disadvantages of process metrics in healthcare are that they do not measure patient experience and clinical outcome, which could be poor despite efficient processes, and do not necessarily translate to good clinical safety and quality. Of the 22 studies, only 1 reported reduced maternal readmission rates, 25 whereas 12 found no increase, 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 28 , 30 , 37 and the remaining 9 studies did not report this outcome. 15 , 16 , 23 , 24 , 27 , 29 , 35 , 36 , 37 One RCT showed a reduction in readmission rates associated with ERAC implementation.…”

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Seven new studies have been published since these reviews, which fulfill the same inclusion criteria. 12 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 There have been a number of identified perceived barriers to successful ERAS implementation, including staff shortages, lack of policy support, poor doctor–patient collaboration, poor multidisciplinary collaboration, and high costs. 32 The reasons are broad, but engaging the multidisciplinary team through consensus on guideline development, involvement in audit and quality improvement, and development of patient education materials are strategies that could improve implementation.…”

“…There have since been 11 new peer-reviewed ERAC studies published that fulfill the same inclusion criteria as Sultan et al, 12 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 and 2 published meta-analyses comparing ERAC with standard care. 33 , 46 In the 22 ERAC implementation studies published to date, the outcomes described are wide-ranging and heterogeneous ( Table 1 ).…”