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Related Concept Videos

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Related Experiment Video

Updated: Jan 19, 2026

Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
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Making enhanced recovery the norm not the exception.

D P Slakey1, D S Silver2, S M Chazin3

  • 1Advocate Aurora Health, United States.

American Journal of Surgery
|September 26, 2019
PubMed
Summary

Enhanced Recovery After Surgery (STAAR) protocols were successfully expanded to multiple surgical services using a Lean process. This initiative significantly reduced length of stay and improved patient outcomes without increasing readmissions.

Keywords:
Enhanced recoveryLean methodologySurgical outcomes

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Area of Science:

  • Surgical Care Improvement
  • Process Improvement in Healthcare
  • Multimodal Patient Management

Background:

  • Enhanced Recovery After Surgery (STAAR) is a multimodal care approach to reduce surgical stress.
  • While established in colorectal surgery, its widespread adoption in other disciplines is limited.

Purpose of the Study:

  • To implement a Lean process for expanding STAAR protocols across various surgical service lines.
  • To assess the impact of Lean-driven STAAR implementation on patient care and outcomes.

Main Methods:

  • A Lean process was employed to facilitate the expansion of STAAR protocols.
  • Implementation involved extensive educational and administrative meetings and rounding.
  • STAAR utilization was defined by >60% compliance.

Main Results:

  • STAAR was expanded to 13 surgical services, involving over 130 surgeons and impacting >6000 patients annually within 12 months.
  • Length of stay (LOS) was reduced by up to 40%.
  • Mortality index and transfusion rates decreased by 67% and 23%, respectively, with no increase in readmissions, infections, or ER visits.

Conclusions:

  • A Lean process successfully integrated STAAR protocols as standard practice.
  • Extensive senior surgical leadership commitment was crucial for this implementation.