Bottom Line:
Author: Cristina B. Geltzeiler, M.D., of Oregon Health and Science University, Portland, and colleagues.
Background: The fundamental aspects of enhanced recovery after surgery (ERAS) programs are guidelines that focus on patient education, optimal fluid management, minimal incision length, decreased use of tubes and drains, opioid-sparing analgesia, and early mobilization and eating after surgery. Most of the literature on ERAS programs is from international or specialized academic centers. The feasibility of such a program in a community hospital setting is largely unknown.
How the Study Was Conducted:
Results: From 2009 to 2012, the use of laparoscopy increased from 57.4 percent to 88.8 percent, length of stay decreased (6.7 days vs. 3.7 days) without an increase in the 30-day readmission rate (17.6 percent vs. 12.5 percent), use of patient-controlled narcotic analgesia and duration of use decreased (63.2 percent of patients vs. 15 percent and 67.8 hours vs. 47.1 hours), ileus (defined as reinsertion of nasogastric tube) rate decreased (13.2 percent to 2.5 percent) and intra-abdominal infection decreased from 7.4 percent to 2.5 percent. Reductions in the length of hospital stays resulted in estimated costs savings of $3,202 per patient in 2011 and $4,803 per patient in 2012.
Discussion: "We have demonstrated with this study that a colorectal ERAS program can be effectively applied to and integrated within a community hospital setting."
( JAMA Surgery . Published online July 23, 2014. doi:10.1001/jamasurg.2014.675. Available pre-embargo to the media at http://media.jamanetwork.com .)
Editor's Note:
Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Media Advisory:
To contact author Cristina B. Geltzeiler, M.D., call Elisa Williams at 503-494-4530 or email willieli@ohsu.edu .
JAMA Surgery