Benchmark Early Compliance Using the Enhanced Recovery after Surgery (ERAS) Interactive Audit System in Collaboration with the International ERAS Society

INTRODUCTION: As the single Academic Center of Excellence in the US for the International ERAS Society, we perform real-time data monitoring of 21 cystectomy-specific variables across 3 phases. To our knowledge, no reports of compliance with Enhanced Recovery after Surgery (ERAS) variables in radical cystectomy patients have been published. We sought to evaluate compliance across 3 phases (pre-, intra-, and postoperative periods) that ultimately constitute overall compliance per ERAS society guidelines. METHODS: Before January 1, 2017, data from 55 cystectomy patients were collected before beginning our regimented ERAS protocol. Between January 1, 2017 and September 30, 2017, forty-six consecutive, post-ERAS patients were entered into the ERAS Interactive Audit System (EIAS). For this report, data were exported from the EIAS and statistically analyzed using Fisher’s exact tests. Results for 6 variables across 2 phases of our 21 variable, 3-phase timeline are depicted (Table). We present a snapshot of the compliance data continuously fed back to staff and providers to offer a more fully inclusive picture of our institution’s ERAS population. RESULTS: We revealed significant compliance improvement across the 3 phases when comparing pre- and post-ERAS cohorts (Table) with a total pre-ERAS compliance of 66.7% as compared to 85.7% post-ERAS (p < 0.01). Specifically, improvement was seen with preoperative education, bowel preparation, preoperative oral carbohydrates, stimulation of gut, and mobilization on postoperative days 1 and 2.Table: No Caption available.CONCLUSIONS: Our early experience with ERAS has demonstrated excellent compliance, setting a benchmark rate of 85.7% compliance during the first year. These results lend support for a team-integrated approach and analytical investment that enables real-time monitoring and feedback.