Enhanced recovery protocol improves colorectal surgery outcomes

An enhanced recovery pathway improved colorectal surgery outcomes and reduced costs at a community hospital in Chicago, according to new research shared at the American College of Surgeons 2017 Quality and Patient Safety Conference.

Enhanced recovery after surgery (ERAS) protocols, also known as fast-track protocols, describe a multi-disciplinary approach that spans the preoperative period through aftercare to speed recovery after surgery and reduce costs and complications.

The American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons just recently issued joint clinical practice guidelines for enhanced recovery after colon and rectal surgery. Standard colorectal surgery can be associated with long hospital stays (5-8 days), high costs, almost a 20% surgical site infection rate, up to an 80% incidence of perioperative nausea and vomiting, and up to a 35.4% readmission rate, the guideline committee wrote.

The Enhanced Recovery After Colorectal Surgery (ERACS) pathway implemented in 2015 at Advocate Illinois Masonic Medical Center in Chicago reduced hospital stays by more than half, complications by more than a third, and costs by up to $11,000 per procedure, according to surgery resident Deepa Bhat, MD, who presented the study results.

"We found that not only does our pathway not negatively impact ... hospital length of stay, readmission rate, and complication rates, but that ERACS actually improves these outcomes,” Bhat said in a press release. “Our goal was to determine whether we could send patients home sooner after surgery without having to worry about increased complications or increased readmission rates.”

Bhat and colleagues retrospectively reviewed all patients who underwent elective colorectal surgery at their large urban community teaching hospital from 2014-2015 (n = 246), and assessed outcomes before and after the ERACS was implemented.

They found that the average length of stay dropped from 5.65 to 2.89 days, that the direct variable cost dropped by about $3,705, and total hospital costs dropped up to $11,227 per patient, which translated to about $1 million in annual savings for the hospital. In addition, the 30-day readmission rate remained stable despite the reduced length of stay.

“Before the enhanced recovery pathway, each surgeon had their own way of doing things, such as when patients should start liquids or when they could be discharged home from the hospital,” Bhat said in the press release. "Now, care is standardized so that every patient experiences the same pre-, intra-, and postoperative protocol, which leads to better outcomes.”

A key element of this pathway is patient coaching and education, she added.

“The patient goes into surgery having a very clear idea of what they can expect, such as how their pain will be controlled, when they can start liquids, and what their expectations are for ambulation,” she said. “By making patients active participants in their own care, they tend to do better.”

Considering these results, the hospital has made the pathway standard practice and plans to develop enhanced recovery protocols for other surgeries, according to the press release. – by Adam Leitenberger

Reference:

Bhat D, et al. “A Dramatic Decrease in the Length of Stay Following Implementation of an Enhanced Recovery Pathway Following Elective Colorectal Surgery.” Presented at: American College of Surgeons 2017 Quality and Patient Safety Conference; July 21-24, 2017; New York, NY.

Disclosures: The researchers report no relevant financial disclosures.