Key result
Implementation of an Enhanced Recovery After Surgery protocol significantly reduced mean length of stay from 6.9 to 5.1 days (p<0.0001) and saved approximately $3,000 per patient.
Why the study?
Does Enhanced Recovery After Surgery (ERAS) protocol implementation reduce cost, length-of-stay, readmission rate, and complications in patients undergoing elective bowel resection in a rural setting?
Cohort (n=438)
No
Does Enhanced Recovery After Surgery (ERAS) protocol implementation reduce cost, length-of-stay, readmission rate, and complications in patients undergoing elective bowel resection in a rural setting?
Mean Difference: -1.8
Absolute Event Rate: 5.1% vs 6.9%
p-value: p=<0.0001
Implementation of an ERAS protocol for elective bowel resection in a rural hospital significantly reduced length of stay and hospital costs without increasing readmissions or complications.
Supports ERAS evaluation in rural bowel resection; extends observational data but leaves causal benefits open to RCTs.
Background: Rural hospitals face unique challenges to adopting Enhanced Recovery protocols after colorectal surgical procedures. There are few examples of successful implementation in the United States, and fewer yet of prospective, outcomes-based trials. Methods: This study drew data from elective bowel resection prospectively collected, retrospectively analyzed cases 2 years prior (n=214) and 3 years after (n=224) implementing an ERAS protocol at a small, rural health network in upstate New York. Primary outcomes were cost, length-of-stay, readmission rate, and complications.Results: The implementation required changes and buy-in at multiple levels of the institution. There was a statistically significant reduction in mean length of stay (6.9 versus 5.1 days) and per-patient savings to hospital ($3000) after implementation of ERAS protocol. There was no significant change in rate of 30-day readmissions or complications. Conclusions: The authors conclude that for rural-specific barriers to implementation of Enhanced Recovery protocols there are specific organizational strategies that can ultimately yield sustainable endpoints.
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Smucker et al. (2020) conducted a cohort in Elective bowel resection (n=438). Enhanced Recovery After Surgery (ERAS) protocol vs. Pre-ERAS standard care was evaluated on Mean length of stay (days) (MD -1.8 days, p=<0.0001). Implementation of an Enhanced Recovery After Surgery protocol significantly reduced mean length of stay from 6.9 to 5.1 days (p<0.0001) and saved approximately $3,000 per patient.
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