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ERAS protocol validation in a propensity-matched cohort of patients undergoing colorectal surgery

  • Original Article
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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Enhanced recovery after surgery (ERAS) provides many benefits. However, important knowledge gaps with respect to specific components of enhanced recovery after surgery remain because of limited validation data. The aim of the study was to validate a mature ERAS protocol at a different hospital and in a similar population of patients.

Methods

This is a retrospective analysis of patients undergoing elective colorectal surgery from 2009 through 2016. Patients enrolled in ERAS are compared with those undergoing the standard of care. Patient demographic characteristics, length of stay, pain scores, and perioperative morbidity are described.

Results

Patients (1396) were propensity matched into two equal groups (ERAS vs non-ERAS). No significant difference was observed for age, Charlson Comorbidity Index, American Society of Anesthesiologists score, body mass index, sex, operative approach, and surgery duration. Median length of stay in ERAS and non-ERAS groups was 3 and 5 days (P < .001). Mean pain scores were lower in the ERAS group, measured at discharge from the postanesthesia unit (P < .001), on postoperative day 1 (P = .002) and postoperative day 2 (P = .02) but were identical on discharge.

Conclusions

This ERAS protocol was validated in a similar patient population but at a different hospital. ERAS implementation was associated with an improved length of stay and pain scores similar to the original study. Different than most retrospective studies, propensity score matching ensured that groups were evenly matched. To our knowledge, this study is the only ERAS validation study in a propensity-matched cohort of patients undergoing elective colorectal surgery.

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Funding

Funding provided by Robert D. and Patricia E. Kern Center for Science of Health Care Delivery. The funder had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Section of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA

    Riccardo Lemini, Amit Merchea & Dorin T. Colibaseanu

  2. Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA

    Aaron C. Spaulding & James M. Naessens

  3. Department of Health Sciences Research, Biostatistics Unit, Mayo Clinic, Jacksonville, FL, USA

    Zhuo Li, Julia E. Crook & Dorin T. Colibaseanu

  4. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    David W. Larson

Authors
  1. Riccardo Lemini
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  2. Aaron C. Spaulding
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  3. James M. Naessens
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  4. Zhuo Li
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  5. Amit Merchea
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  6. Julia E. Crook
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  7. David W. Larson
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  8. Dorin T. Colibaseanu
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Contributions

All authors made substantial contribution to the conception and design of the work, as well as the acquisition, analysis, and interpretation of data. All authors were critically involved in drafting and revising this project for important intellectual content. Final approval of the version to be published was given by all authors, and they agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Dorin T. Colibaseanu.

Ethics declarations

The Mayo Clinic Institutional Review Board approved this retrospective study. This study followed the reporting guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

This manuscript was presented as a “quick shot presentation” at the 13th annual Academic Surgical Congress, January 30-February 1, 2018, Jacksonville, Florida.

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Lemini, R., Spaulding, A.C., Naessens, J.M. et al. ERAS protocol validation in a propensity-matched cohort of patients undergoing colorectal surgery. Int J Colorectal Dis 33, 1543–1550 (2018). https://doi.org/10.1007/s00384-018-3133-4

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  • DOI: https://doi.org/10.1007/s00384-018-3133-4

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