Enhanced Recovery Programs in an Ambulatory Surgical Oncology Center

Area of Science:

• Ambulatory surgery
• Surgical oncology
• Quality improvement

Background:

• Enhanced Recovery After Surgery (ERAS) programs aim to optimize surgical patient care.
• Key ERAS components include preoperative education, hydration, PONV prophylaxis, fluid management, and multimodal analgesia.
• These programs are designed to minimize postoperative nausea and vomiting (PONV), pain, and opioid consumption.

Purpose of the Study:

• To assess the implementation and impact of ERAS programs in an ambulatory cancer surgery setting.
• To evaluate the effect of ERAS on postoperative outcomes such as PONV, pain, and opioid use.
• To provide benchmarking data for ERAS implementation in ambulatory cancer surgery.

Main Methods:

• Retrospective review of 6781 ambulatory surgery cases (mastectomy, hysterectomy, thyroidectomy, prostatectomy) from January 2016 to December 2018.
• Data collected included total intravenous anesthesia (TIVA) use, PONV rescue rates, time to first oral opioid, and opioid consumption.
• Compliance with ERAS elements and quality outcomes (ambulation, LOS, reoperation, readmission) were analyzed.

Main Results:

• PONV rescue rates decreased significantly, particularly for mastectomies (28% decrease).
• TIVA use increased, and intraoperative opioid administration decreased across procedures.
• Time to first oral opioid was reduced for all surgeries, though postoperative opioid consumption remained largely unchanged.

Conclusions:

• ERAS implementation is feasible in an ambulatory surgery center setting.
• The study provides valuable benchmarking data on postoperative outcomes during the initial 3 years of ERAS.
• Further research with control groups is needed to establish definitive associations between ERAS components and outcome improvements.