Enhanced recovery protocols significantly reduced median postoperative length of stay compared to non-ERP care (4.8 vs. 7.0 days, p<0.001) in patients undergoing infra-inguinal arterial bypass.
Cohort (n=257)
No
Does an enhanced recovery protocol (ERP) improve postoperative outcomes in frail patients undergoing infra-inguinal arterial bypass?
High frailty is not a barrier to ERP implementation, and ERP is associated with improved postoperative outcomes, including reduced length of stay, in highly frail patients undergoing infra-inguinal arterial bypass.
Absolute Event Rate: 4.8% vs 7%
p-value: p=<0.001
OBJECTIVE: The aim of this study was to evaluate the impact of frailty on enhanced recovery protocol (ERP) compliance and the impact of ERP on adverse postoperative outcomes in frail patients undergoing infra-inguinal arterial bypass (IB). METHODS: We performed a retrospective single-institution study of patients undergoing IB (2021-2024). Patients were categorized into three frailty groups using the NSQIP 5-item frailty index where F1=less frail (F1=0-1 risk factor; F2=2 risk factors; F3=3-5 risk factors). The association between frailty and both ERP compliance and postoperative outcomes were analyzed. Chi-square and Fisher's exact tests were used for categorical variables while continuous variables were analyzed by Kruskal-Wallis test. Time-to-event outcomes were assessed using Kaplan-Meier survival analysis in the elective intervention cohort, with follow-up truncated at 30 days. RESULTS: 257 patients were identified and stratified by frailty (F1=32.7%; F2=36.6%; F3=30.7%). F1 patients were significantly younger (mean age in years F1=65.0; F2=71.6; F3=71.6; p <0.001) and less likely to present with tissue loss (F1=31.0%; F2=47.9%; F3=62.0%; p<0.001). ERP compliance was not associated with frailty (F1=57.1%; F2=54.8%; F3=61.5%; p=0.739). Overall, patients who underwent ERP had a significantly shorter median postoperative LOS compared to non-ERP patients (4.8 vs. 7.0 days, p<0.001). Within the F3 cohort, ERP compliance was associated with lower reintervention rate (ERP=15.0% vs. non-ERP=33.3%; p=0.050); lower postoperative length of stay (ERP=7.9 days vs. non-ERP=9.8 days, p=0.016); and a reduction in 30-day mortality (ERP=2.5% vs. non-ERP=7.7%; p=0.298). In time-to-event analysis of elective procedures, no differences were observed in the 30-day freedom from reintervention, readmission or mortality. CONCLUSION: High frailty was not a barrier to the implementation of ERP and ERP was associated with improved postoperative outcomes in highly frail patients.
Lopes et al. (Fri,) conducted a cohort in Infra-inguinal arterial bypass (n=257). Enhanced recovery protocol (ERP) vs. Non-ERP was evaluated on Postoperative length of stay (days) (p=<0.001). Enhanced recovery protocols significantly reduced median postoperative length of stay compared to non-ERP care (4.8 vs. 7.0 days, p<0.001) in patients undergoing infra-inguinal arterial bypass.