Evaluation of an enhanced recovery after surgery (ERAS) initiative

Abstract

Purpose: To determine if patient outcomes and compliance with best practice guidelines improved when an Enhanced Recovery After Surgery (ERAS) program was implemented for elective colorectal resections at St. Clare’s Mercy Hospital (SCMH) in St. John’s, Newfoundland and Labrador (NL). Methods: Interrupted time-series analysis was utilized to compare patient outcomes and guideline compliance between surgeries that were performed under standard practice (April 1, 2014 to March 31, 2015) and those performed during the first year of the ERAS program (March 1, 2016 to February 28, 2017). An ERAS Coordinator supervised guideline compliance in the first six months of ERAS surgeries. Charts were manually reviewed to obtain patient outcomes and compliance with guidelines. Results: Length of stay (LOS) decreased significantly from 7.26 days in the control (standard practice) group to 6.27 days in the ERAS group. LOS was shorter in the first six months of ERAS (5.44 days) than in the second six months of ERAS (7.10 days). There were no statistically significant differences in rates of complication, readmission, or mortality with implementation of ERAS. Overall compliance with guidelines increased significantly from 52.2% to 77.7% with implementation of ERAS. Postoperative compliance decreased (79.2% to 68.6%) from the first six months to the second six months of ERAS. Conclusion: Implementation of ERAS was successful at reducing LOS, but not rates of complication, readmission, or mortality. The success of this program appears to have been largely dependent on guideline supervision by an ERAS coordinator in the first six months. Methods for ensuring postoperative compliance are vital to the success of similar programs in the future.