The Impact of an Enhanced Recovery after Surgery (ERAS) Protocol Implementation in a Community-Based Hospital.

Abstract

Study Objective Does ERAS reduce opioid usage without adversely impacting patient satisfaction, length of stay (LOS) readmissions and complications? Design Retrospective quality care improvement study Setting Intercity community Hospital Patients or Participants Patients undergoing major Gynecologic surgery by Gynecologic oncology service. Interventions: ERAS protocol. For Minimally invasive Surgery (MIS) cases, gabapentin 24 hours prior to surgery was started, and was continued for 2 days postoperatively. Multimodal analgesia was used in the postoperative period. Measurements and Main Results Post ERAS implementation cases were compared with a cohort of consecutive patients undergoing major surgery 2 years prior to implementation. No significant differences in demographic, surgical or clinical characteristics were demonstrated. 174 cases were completed by MIS. LOS was similar before and after implementation (2.82 vs 2.71, p= 0.339), open cases had a longer LOS before ERAS (> 4 days in 16 (80%) vs 12 (63%, p=0.122). LOS for MIS before and after ERAS was no different (75.6% pre ERAS vs 78% after ERAS, p=0.339). After ERAS protocols, there was a significant decrease in amount of overall opioid usage (90 vs 61 P Conclusion ERAS was effective in decreasing the amount of opioid use at a large intercity community hospital.