Key result
Implementation of an Enhanced Recovery After Surgery (ERAS) protocol significantly reduced mean length of stay from 6.9 to 5.1 days (p<0.0001) and yielded per-patient savings of $3,000.
Why the study?
Does an ERAS protocol reduce cost, length of stay, readmissions, and complications in patients undergoing elective bowel resection in a rural hospital?
Cohort (n=438)
No
Does an ERAS protocol reduce cost, length of stay, readmissions, and complications in patients undergoing elective bowel resection in a rural hospital?
Mean Difference: -1.8
Absolute Event Rate: 5.1% vs 6.9%
p-value: p=<0.0001
Implementation of an ERAS protocol in a rural hospital significantly reduced length of stay and hospital costs without increasing readmissions or complications.
May support ERAS in rural hospitals; extends observational data but leaves open need for randomized confirmation.
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 also 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, p=<0.0001). Implementation of an Enhanced Recovery After Surgery (ERAS) protocol significantly reduced mean length of stay from 6.9 to 5.1 days (p<0.0001) and yielded per-patient savings of $3,000.
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