32: ENHANCED RECOVERY AFTER SURGERY CAN IMPROVE PATIENTS’ OUTCOMES AND REDUCE HOSPITAL COST OF GASTRECTOMY FOR CANCER IN THE WEST. A PROPENSITY SCORE-BASED ANALYSIS

Abstract

Abstract Background and aim Data on ERAS for gastrectomy are scarce and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical conditions and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center. Methods We conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate and compliance with ERAS items. A propensity score (PS) was built on confounding variables. Results Compliance with ERAS items after the program was ≥70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in ERAS group. PS-based multivariable analysis confirmed a significant 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not significantly change. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted: median reduction was one day and €775, respectively. Conclusion ERAS for gastrectomy improved patients’ recovery and reduced hospital costs without changes in morbidity, mortality or readmission.