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Impact of Multi-Institutional Enhanced Recovery after Surgery Protocol Implementation on Elective Colorectal Surgery
Marta Antoniv1, Andrei Nikiforchin2, Naomi M Sell3
1From the Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Antoniv, Ahmed, Bleday).
Implementing enhanced recovery after surgery (ERAS) protocols significantly reduces complications and hospital stays for elective colorectal surgery patients. This multi-institutional approach improves outcomes and lowers readmissions, supporting wider adoption for better patient care.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Patient Recovery Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols aim to optimize surgical patient outcomes.
- The effectiveness of ERAS protocols can vary, necessitating further investigation into multi-institutional implementation.
- This study specifically evaluated the impact of ERAS on postoperative morbidity in elective colorectal surgery.
Purpose of the Study:
- To assess the impact of multi-institutional Enhanced Recovery After Surgery (ERAS) implementation on postoperative morbidity.
- To analyze changes in complication rates, length of stay, and readmission rates.
- To determine the association between ERAS protocols and patient outcomes in elective colorectal surgery.
Main Methods:
- A multicenter retrospective cohort study utilizing the American College of Surgeons NSQIP database (2012-2020).
- Analysis of patient outcomes before (2012-2014) and after (2015-2020) ERAS implementation across four hospitals.
- Multivariable logistic regression to identify the impact of ERAS on specific outcomes.
Main Results:
- The ERAS cohort (5,357 cases) showed significant reductions in surgical site infections, urinary tract infections, pulmonary embolism, deep vein thrombosis, and sepsis compared to the pre-ERAS cohort (3,573 cases).
- Median length of stay decreased from 5 to 4 days, and 30-day readmission rates dropped from 11.3% to 9.8%.
- ERAS implementation was linked to a 35% decrease in the odds of all 30-day complications (OR 0.65), with no significant effect on mortality rates.
Conclusions:
- Standardized, multi-institutional ERAS protocols significantly enhance outcomes for elective colorectal surgery.
- ERAS implementation leads to reduced complications, shorter hospital stays, and fewer readmissions.
- These findings advocate for the broader adoption of ERAS protocols to improve patient care and reduce healthcare costs.
