Association of Enhanced Recovery After Surgery Implementation and Comparative Outcomes Improvement at an Academic...

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Enhanced Recovery After Surgery (ERAS)

Background:

• Enhanced recovery after surgery (ERAS) protocols are hypothesized to improve surgical outcomes in colorectal procedures.
• The long-term sustainability of ERAS program benefits in colorectal surgery remains an area of investigation.

Purpose of the Study:

• To evaluate the long-term impact and sustainability of a comprehensive ERAS program implemented for colorectal surgery.
• To compare the outcomes at Johns Hopkins Hospital (JHH) with national trends using difference-in-differences (DID) analysis.

Main Methods:

• A pre-post analysis compared outcomes at JHH from 2012-2013 (baseline) to 2018-2019 (postimplementation).
• Difference-in-differences (DID) regression analyzed JHH outcomes against a national sample (>700 hospitals) from the National Surgical Quality Improvement Program (NSQIP).
• Outcomes analyzed included length of stay (LOS), surgical site infections (SSIs), and readmission rates, controlling for patient and procedural variables.

Main Results:

• Pre-post analysis showed significant reductions in SSIs (4.4%) and readmissions (5.6%) at JHH, with no significant change in LOS.
• DID analysis indicated statistical equivalence for SSIs (OR 0.80) but greater improvement in readmission rates (OR 0.62) at JHH compared to national trends.
• DID analysis revealed less improvement in LOS at JHH (IRR 1.17) compared to national trends, suggesting a potential trade-off.

Conclusions:

• ERAS implementation at JHH led to sustained improvements in colorectal surgery outcomes over six years, comparable or superior to national trends.
• The findings support the adoption of ERAS programs for achieving long-term improvements in colorectal surgery.
• A potential trade-off between reduced readmission rates and increased length of stay was observed.