Dataset Information

The impact of variations in care and complications within a colorectal enhanced recovery after surgery (ERAS) program on length of stay.

ABSTRACT: Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay. This study was a single-centre review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on length of stay (LOS). The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, surgical site infections) on LOS. ERAS interventions, rate of adherence, length of stay, readmissions, morbidity and mortality was recorded and analysis was performed on SPSS. While there was a high agreement rate for pre-operative ERAS strategies, there was a lower agreement rate for post-operative ERAS interventions. ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. Seven ERAS interventions were identified as the most important strategies in reducing LOS. These include laparoscopic surgery, mobilisation twice daily post-operative day (POD) 0-1, discontinuation of intravenous fluids on POD 0-1, upgrading to solid diet by POD 0-2, removal of indwelling catheter by POD 0-2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.

SUBMITTER: Toh JWT

PROVIDER: S-EPMC8898630 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay.

Toh James Wei Tatt JWT Cecire Jack J Hitos Kerry K Shedden Karen K Gavegan Fiona F Pathmanathan Nimalan N El Khoury Toufic T Di Re Angelina A Cocco Annelise A Limmer Alex A Liang Tom T Fok Kar Yin KY Rogers James J Solis Edgardo E Ctercteko Grahame G

Annals of coloproctology 20210506 1

<h4>Purpose</h4>Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).<h4>Methods</h4>This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ...[more]

PMID: 33957036

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Project description:ObjectiveTo investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery.BackgroundRacial disparities in surgical outcomes exist. We hypothesized that ERAS would reduce disparities in pLOS between black and white patients.MethodsPatients undergoing ERAS in 2015 were 1:1 matched by race/ethnicity, age, sex, and procedure to a pre-ERAS group from 2010 to 2014. After stratification by race/ethnicity, expected pLOS was calculated using the American College of Surgeons National Surgical Quality Improvement Project Risk Calculator. Primary outcome was the observed pLOS and observed-to-expected difference in pLOS. Secondary outcomes were National Surgical Quality Improvement Project postoperative complications including 30-day readmissions and mortality. Adjusted sensitivity analyses on pLOS were also performed.ResultsOf 420 patients (210 ERAS and 210 pre-ERAS) examined, 28.3% were black. Black and white patients were similar in age, body mass index, sex, American Anesthesia Association class, and minimally invasive approaches. Within the pre-ERAS group, black patients stayed a mean of 2.7 days longer than expected compared with white patients (P < 0.05). Overall, ERAS patients had a significantly shorter pLOS (5.7 vs 8 days) and observed-to-expected difference (-0.7 vs 1.4 days) compared with pre-ERAS patients (P < 0.01). In the ERAS group, disparities in pLOS were reduced with no differences in readmissions or mortality between black and white patients. On sensitivity analyses, race/ethnicity remained a significant predictor of pLOS among pre-ERAS patients, but not for ERAS patients.ConclusionsERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications. ERAS may provide a practical approach to reducing disparities in surgical outcomes.

Project description:BackgroundIncreased length of stay after surgery is associated with increased healthcare utilization and adverse patient outcomes. While enhanced recovery after surgery (ERAS) protocols have been shown to reduce length of stay after colorectal surgery in trial settings, their effectiveness in real-world settings is more uncertain. The aim of this study was to assess the impact of ERAS protocol implementation on length of stay after colorectal surgery, using real-world data.MethodsIn 2012, ERAS protocols were introduced at 15 Ontario hospitals as part of the iERAS study. A cohort of patients undergoing colorectal surgery treated at these hospitals between 2008 and 2019 was created using health administrative data. Mean length of stay was computed for the intervals before and after ERAS implementation. Interrupted time series analyses were performed for predefined subgroups, namely all colorectal surgery, colorectal surgery without complications, right-sided colorectal surgery, and left-sided colorectal surgery. Sensitivity analyses were then conducted using adjusted length of stay, accounting for length of stay predictors, including: patient age, sex, marginalization, co-morbidities, and diagnosis; surgeon volume of cases, years in practice, and colorectal surgery expertise; hospital volume; and other contextual factors, including procedure type and timing, surgical approach, and in-hospital complications.ResultsA total of 32 612 patients underwent colorectal surgery during the study interval. ERAS implementation led to a decrease in length of stay of 1.05 days (13.7%). Larger decreases in length of stay were seen with more complex surgeries, with a level change of 1.17 days (15.6%) noted for the subgroup of patients undergoing left-sided colorectal surgery. The observed decreases in length of stay were durable for the length of the study interval in all analyses. When adjusting for predictors of length of stay, the effect of ERAS implementation on length of stay was larger (reduction of 1.46 days).ConclusionIntroducing formal ERAS protocols reduces length of stay after colorectal surgery significantly, independent of temporal trends toward decreasing length of stay. These effects are durable, demonstrating that ERAS protocol implementation is an effective hospital-level intervention to reduce length of stay after colorectal surgery.

Dataset Information

The impact of variations in care and complications within a colorectal enhanced recovery after surgery (ERAS) program on length of stay.

Publications

The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay.

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