Improving Gastrointestinal Cancer Care by Enhanced Recovery Protocol Implementation

Area of Science:

• Surgical Outcomes Research
• Health Services Research
• Patient Recovery Protocols

Background:

• Enhanced Recovery Protocols (ERPs) are standard for elective small bowel surgeries but understudied in community hospitals.
• A multidisciplinary ERP was developed at a community hospital, incorporating minimal anesthesia, early ambulation, enteral nutrition, and multimodal analgesia.

Purpose of the Study:

• To evaluate the impact of an implemented ERP on postoperative length of stay (LOS).
• To assess the effect of ERP on readmission (RA) rates following bowel surgery.
• To determine the influence of ERP on overall postoperative outcomes in a community hospital.

Main Methods:

• Retrospective review of major bowel resection patients (DRG 329, 330, 331) at Holy Cross Hospital (HCH) from 2017.
• Comparison of outcomes between ERP and non-ERP cases at HCH.
• Retrospective review of Medicare claims database (CMS) to compare HCH data with national averages for LOS and RA.

Main Results:

• Significant reductions in mean LOS were observed for all studied DRGs in ERP patients compared to non-ERP patients at HCH (P ≤ 0.001).
• HCH's LOS for DRGs 329, 330, and 331 improved to the 90th, 72nd, and 54th percentiles, respectively, compared to national CMS data (P < 0.001).
• Readmission rates at HCH for ERP and non-ERP cases were consistently low (3% at 30 and 90 days), significantly outperforming national CMS averages for all DRGs.

Conclusions:

• Implementation of ERP in a community hospital setting significantly improved postoperative outcomes, including reduced LOS and low RA rates.
• ERP outcomes at HCH surpassed both non-ERP cases and national averages, validating its effectiveness in this setting.
• Further research is recommended to explore ERP's impact in other surgical fields and community hospital settings.