Implementation at 20 hospitals of an enhanced recovery after surgery program among patients undergoing elective colorectal resection or emergency hip fracture repair was associated with decreases in hospital length of stay and postoperative complication rates, according to a study published by JAMA Surgery.
To reduce complications and improve outcomes after surgery, bundled surgical care approaches have been proposed that aim to reduce the stress of surgery and maximize the potential for recovery.
Vincent X. Liu, MD, MS, of Kaiser Permanente, Oakland, and colleagues evaluated the outcomes of an enhanced recovery after surgery (ERAS) program designed with a particular focus on perioperative pain management, mobility, nutrition, and patient engagement. The study included a total of 3,768 patients undergoing elective colorectal resection and 5,002 patients undergoing emergency hip fracture repair. Comparison surgical patients included 5,556 patients undergoing elective gastrointestinal surgery and 1,523 patients undergoing emergency orthopedic surgery.
The researchers found that implementation of the ERAS program resulted in significant practice changes, including those for mobility, nutrition, and opioid use. Hospital length of stay and postoperative complication rates were significantly lower among patients in the ERAS group. Among patients undergoing colorectal resection, ERAS implementation was associated with decreased rates of hospital mortality, whereas among patients with hip fracture, implementation was associated with increased rates of home discharge.
Several strengths and limitations of the study are noted in the article.
“Rapid, large-scale implementation of a multidisciplinary ERAS program is feasible and effective in improving surgical outcomes,” the authors write.