Abstract
BackgroundRural 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.MethodsThis 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.ResultsThe 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.ConclusionsThe authors conclude that for rural-specific barriers to implementation of Enhanced Recovery protocols there are specific organizational strategies that can ultimately yield sustainable endpoints.
Highlights
Rural hospitals face unique challenges to adopting Enhanced Recovery protocols after colorectal surgical procedures
The Enhanced Recovery After Surgery (ERAS) Society --- established in 2010 --- began to create accessible education materials and audit systems to disseminate and encourage early adoption of best perioperative practices throughout the world [2]
ERAS protocols rely on a multitude of practices which invariably include detailed preoperative education and counseling, medical optimization, tight glycemic control, maintenance of normothermia, multimodal analgesia, opioid reduction, early feeding, early mobilization, and early catheter removal
Summary
Rural hospitals face unique challenges to adopting Enhanced Recovery protocols after colorectal surgical procedures. Rural hospitals face relative challenges in the adoption of Enhanced Recovery After Surgery (ERAS) protocols for their patients. The ERAS Society --- established in 2010 --- began to create accessible education materials and audit systems to disseminate and encourage early adoption of best perioperative practices throughout the world [2]. ERAS protocols have ballooned to encompass multiple surgical specialties beyond colorectal surgery, and can refer to many forms of multi-modal, comprehensive, peri-operative frameworks. ERAS protocols rely on a multitude of practices which invariably include detailed preoperative education and counseling, medical optimization, tight glycemic control, maintenance of normothermia, multimodal analgesia, opioid reduction, early feeding, early mobilization, and early catheter removal
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