Development of an Enhanced Recovery After Surgery Program in Ventral Hernia

Area of Science:

• Surgical Pathway Development
• Hernia Surgery Outcomes
• Enhanced Recovery Protocols

Background:

• Enhanced Recovery After Surgery (ERAS) programs, initially successful in colorectal surgery, are evolving for ventral hernia repair.
• Ventral hernia repair presents unique challenges for ERAS pathway adoption.
• This study details the creation and implementation of a specialized ERAS pathway for ventral hernia patients.

Purpose of the Study:

• To develop and implement a comprehensive Enhanced Recovery After Surgery (ERAS) pathway tailored for ventral hernia repair.
• To evaluate the impact of the ERAS pathway on key clinical outcomes and compliance.
• To establish a standardized, evidence-based approach to ventral hernia patient care.

Main Methods:

• A multidisciplinary team developed a 6-month ERAS pathway incorporating 75 process and outcome measures across all care phases.
• Key components included preoperative optimization, non-opioid multimodal analgesia, early diet, and mobilization.
• A comparative analysis was performed between pre-implementation (PGL) and post-implementation (AGL) periods.

Main Results:

• ERAS compliance improved significantly, rising from 73.9% in the PGL group to 82.9% in the AGL group.
• Average length of stay (LOS) decreased from 2.27 days to 1.92 days post-implementation.
• Average daily postoperative opioid consumption (MME) was reduced by 46.8%, from 25.4 to 13.5.

Conclusions:

• Enhanced Recovery After Surgery (ERAS) is effectively applicable to ventral hernia patient care, leading to tangible improvements.
• Successful implementation requires strong institutional support and robust multidisciplinary collaboration.
• The developed ERAS pathway demonstrates significant reductions in length of stay and opioid utilization for hernia repair.