Implementation of an enhanced recovery program for lower extremity bypass

Area of Science:

• Vascular Surgery
• Enhanced Recovery Programs
• Postoperative Care

Background:

• Enhanced recovery programs (ERPs) are widely adopted in surgery to improve outcomes and reduce hospital length of stay (LOS).
• Limited data exists on ERP implementation and outcomes specifically for vascular surgery patients, particularly for lower extremity bypass procedures.

Purpose of the Study:

• To describe the implementation process and early outcomes of an enhanced recovery program (ERP) for lower extremity bypass surgery.
• To identify barriers encountered during ERP implementation in vascular surgery.
• To provide a framework for other institutions to implement similar ERPs.

Main Methods:

• Utilized a plan-do-check-adjust methodology with a multidisciplinary team.
• Collected patient, procedure, and ERP-specific metrics using a dedicated database.
• Retrospectively analyzed demographic and outcome data for patients undergoing lower extremity bypass surgery with and without ERP.

Main Results:

• ERP implementation involved preoperative, intraoperative, and postoperative phases over 9 months.
• ERP patients demonstrated decreased total LOS (8.32 vs 11.14 days) and postoperative LOS (6.12 vs 7.98 days) compared to non-ERP patients.
• Significant reductions in observed to expected postoperative LOS (P=.005) and both variable (P<.01) and total costs (P=.01) were observed in the ERP group.

Conclusions:

• Implementing an ERP for lower extremity bypass surgery presents challenges but significantly impacts practice patterns.
• Early results indicate that ERPs can reduce hospital LOS and associated costs in vascular surgery.
• The outlined protocol offers a transferable pathway for other institutions to adopt vascular surgery ERPs.