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Value of an interactive phone application in an established enhanced recovery program

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

An interactive mobile phone application was added to an established Enhanced Recovery After Surgery (ERAS) program to determine the impact on ERAS compliance as well as clinical outcomes.

Methods

We identified patients undergoing elective colorectal surgery enrolled in our ERAS program from February 2017 to July 2018. Patients enrolled in a phone application were compared with those not enrolled in terms of age, sex, diagnosis, operative approach, bowel preparation, oral intake and solid food intake, ERAS pathway adherence, and clinical outcomes.

Results

A total of 289 patients were included: 147 enrolled and 142 not enrolled in the phone application. The mean age of enrollees was 53.0 years, compared with 58.3 years for the non-enrollees (p = 0.003). The mean ERAS pathway medication adherence for enrollees was 82.1% versus 76.8% for those not enrolled (p = 0.005). The mean LOS and SSI rates for those enrolled versus not enrolled in the phone application was 4.4 days versus 6.4 days (p = 0.006) and 3.4% versus 11.3% (p = 0.019), respectively. There was no significant difference in readmission rates between enrollees and non-enrollees (15% versus 10.6%, p = 0.345). The mean total cost of patients enrolled was $11,560; total cost of those not enrolled was $13,946 (p = 0.024).

Conclusions

Use of an interactive phone application is associated with improved medication ERAS adherence along with significant reduction in length of stay and SSI rates without increasing total cost.

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References

  1. Rawlingson A, Kang P, Evans J, Khanna A (2011) A systematic review of enhanced recovery protocols in colorectal surgery. Ann R Coll Surg Engl 93:583–588

    Article  Google Scholar 

  2. Ljungqvist O, Scott M, Fearon K (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:800–809

    Article  Google Scholar 

  3. Carmichael J, Keller D, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR (2017) Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60:761–784

    Article  Google Scholar 

  4. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541

    Article  Google Scholar 

  5. Currie A, Malietzis G, Jenkins J, Yamada T, Ashrafian H, Athanasiou T, Okabayashi K, Kennedy RH (2016) Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer. Br J Surg 103:1783–1794

    Article  CAS  Google Scholar 

  6. Jung A, Dhar V, Hoehn R, Atkinson SJ, Johnson BL, Rice T, Snyder JR, Rafferty JF, Edwards MJ, Paquette IM (2018) Enhanced recovery after colorectal surgery: can we afford not to use it? J Am Coll Surg 226:586–593

    Article  Google Scholar 

  7. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617

    Article  CAS  Google Scholar 

  8. Walter CJ, Collin J, Dumville JC, Drew PJ, Monson JR (2009) Enhanced recovery in colorectal resections: a systematic review and meta-analysis. Color Dis 11:344–353

    Article  CAS  Google Scholar 

  9. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840

    Article  Google Scholar 

  10. Pedziwaitr M, Mavrikis J, Witowski J et al (2018) Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol 35:95

    Article  Google Scholar 

  11. Arrick L, Mayson K, Hong T, Warnock G (2019) Enhanced recovery after surgery in colorectal surgery: impact of protocol adherence on patient outcomes. J Clin Anesth 55:7–12

    Article  Google Scholar 

  12. Gustafsson U, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J, Enhanced Recovery After Surgery Study Group (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577

    Article  Google Scholar 

  13. Pecorelli N, Fiore J, Kaneva P et al (2018) An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability. Surg Endosc 32:2263–2273

    Article  Google Scholar 

  14. Mata J, Pecorelli N, Kaneva P et al (2019) A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial. Surg Endosc. https://doi.org/10.1007/s00464-019-06823-w

    Article  Google Scholar 

  15. Thanh NX, Chuck AW, Wasylak T et al (2016) An economic evaluation of the enhanced recovery after surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg 59:415–427

    Article  Google Scholar 

  16. Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hübner M, Schäfer M, Demartines N (2013) The cost effectiveness of the implementation of an enhanced recovery pathway protocol for colorectal surgery. Br J Surg 100:1108–1114

    Article  CAS  Google Scholar 

  17. Aggarwal P, Yong Fadok TM (2016) The cost benefit of implementing an enhanced recover after surgery (ERAS) in colorectal surgery. J Am Col Surg 223:e6–e7

    Article  Google Scholar 

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Correspondence to Joanne Favuzza.

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Schlund, D., Poirier, J., Bhama, A.R. et al. Value of an interactive phone application in an established enhanced recovery program. Int J Colorectal Dis 35, 1045–1048 (2020). https://doi.org/10.1007/s00384-020-03563-5

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