Enhanced Recovery After Surgery protocols mitigate the weekend effect on length of stay following elective colectomy

Abstract

PurposeTo determine the effect of enhanced recovery after surgery (ERAS) protocols on the weekend effect after elective colectomies. MethodsWe performed a retrospective study on all elective colorectal surgeries at a single institution in New York City between January 1st, 2015 and December 31st, 2020. We compared length of stay by day of the week of surgery and the effect of ERAS using univariable and multivariable analysis. Results605 patients were included in the study. Forty-one cases were done on Mondays, 197 on Tuesdays, 45 on Wednesdays, 187 on Thursdays, and 135 on Fridays. Univariate analysis performed showed that for patients who did not undergo ERAS, Monday and Tuesday were significantly associated with decreased length of stay (p-value < 0.001). For patients who underwent ERAS, there was no statistically significant difference in LOS (p-value = 0.06) when operated on early in the week versus later. After controlling for age, race/ethnicity, comorbidities, complications, functional health status, operation type, duration of surgery, presence of ostomy, and albumin, adhering to ERAS protocol was significantly associated with a shorter length of stay (p-value < 0.001). ConclusionOur study demonstrates that ERAS can mitigate the weekend effect on length of stay. ERAS protocols may provide more structure to the expected hospital course and allow patients to reach recovery milestones earlier, facilitating discharge even by covering teams.