Abstract
Introduction
Enhanced recovery after surgery (ERAS) colorectal programs have been shown to improve
the length of stay (LOS) without increasing hospital resource utilization at academic
centers worldwide. A multidisciplinary ERAS protocol that includes preoperative, intraoperative,
and postoperative management guidelines was recently implemented at our urban, racially
diverse, and academically affiliated community hospital. A delivery option was provided
to reduce barriers to care. Given our unique patient population, the objective of
our study was to determine if improvements in outcomes were reproducible in our hospital.
Methods
This is a retrospective study of patients undergoing elective colectomy at New York-Presbyterian
Queens Hospital between January 1, 2015, and December 31, 2020. Patient outcomes were
compared between surgeries performed under standard practice (all colectomies prior
to April 2017) and those performed after the implementation of the ERAS protocol.
Demographic and perioperative data were abstracted from a prospectively derived database
used to submit data to the National Surgical Quality Improvement Program. Additional
data were obtained from chart review.
Results
Six hundred five elective colectomies were performed by 12 surgeons (range 1-228 cases)
during the study period. Of these, 22 were performed open (41% followed ERAS), 467
were performed laparoscopically (57% followed ERAS), and 116 were performed robotically
(74% followed ERAS). The average patient age was 64 y. Of which, 55% were male; 34%
were Asian, 27% were non-Hispanic Caucasian, 27% were Hispanic, and 11% were Black
or African American (all P-values > 0.05 for ERAS versus non-ERAS). Average duration of procedure was longer in the ERAS group (262 min versus 243 min, P = 0.04), although when stratified by procedure type, this relationship held true
only for laparoscopic procedures. Hospital LOS was significantly shorter in the ERAS
group (4.3 versus 5.4 d, P < 0.001) and this relationship held true for procedures performed both laparoscopically
(4.2 versus 5.3 d, P = 0.01) and robotically (4.1 versus 5.1 d, P = 0.04). Of the ERAS group, patients who opted for delivery of ERAS components (n = 205) had the shortest LOS when compared to patients who picked up components (n = 91) or opted out of ERAS (n = 309) (4.1 versus 4.4 versus 5.2 d, P = 0.003). No significant differences were found for 30-d mortality, 30-d readmission,
wound infection, or other postoperative complications (all P-values > 0.05).
Conclusions
Implementation of an ERAS protocol in an urban, diverse, academically affiliated community
hospital is associated with reductions in LOS for colectomies performed both laparoscopically
and robotically. Facilitating ERAS compliance with a delivery option was also associated
with improvements in hospital LOS. Preoperative nutrition supplementation was not
associated with outcomes. No differences in mortality, readmission rates, or rates
of postoperative complications were found.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 10, 2023
Accepted:
December 18,
2022
Received in revised form:
December 6,
2022
Received:
March 3,
2022
Identification
Copyright
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