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Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution

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Abstract

Background

As Enhanced Recovery After Surgery (ERAS®) programs expand across numerous subspecialties, growth and sustainability on a system level becomes increasingly important and may benefit from reporting multidisciplinary and financial data. However, the literature on multidisciplinary outcome analysis in ERAS is sparse. This study aims to demonstrate the impact of multidisciplinary ERAS auditing in a hospital system. Additionally, we describe developing a financial metric for use in gaining support for system-wide ERAS adoption and sustainability.

Methods

Data from HPB, colorectal and urology ERAS programs at a single institution were analyzed from a prospective ERAS Interactive Audit System (EIAS) database from September 2015 to June 2019. Clinical 30-day outcomes for the ERAS cohort (n = 1374) were compared to the EIAS pre-ERAS control (n = 311). Association between improved ERAS compliance and improved outcomes were also assessed for the ERAS cohort. The potential multidisciplinary financial impact was estimated from hospital bed charges.

Results

Multidisciplinary auditing demonstrated a significant reduction in postoperative length of stay (LOS) (1.5 days, p < 0.001) for ERAS patients in aggregate and improved ERAS compliance was associated with reduced LOS (coefficient − 0.04, p = 0.004). Improved ERAS compliance in aggregate also significantly associated with improved 30-day survival (odds ratio 1.04, p = 0.001). Multidisciplinary analysis also demonstrated a potential financial impact of 44% savings (p < 0.001) by reducing hospital bed charges across all specialties.

Conclusions

Multidisciplinary auditing of ERAS programs may improve ERAS program support and expansion. Analysis across subspecialties demonstrated associations between improved ERAS compliance and postoperative LOS as well as 30-day survival, and further suggested a substantial combined financial impact.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA

    Ryan C. Pickens, William B. Lyman, Lacey King, David A. Iannitti, John B. Martinie, Erin H. Baker, Lee M. Ocuin & Dionisios Vrochides

  2. Carolinas Center for Surgical Outcomes Science, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Allyson R. Cochran

  3. Division of Urology and Urologic Oncology, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Stephen B. Riggs

  4. Division of Colorectal Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Bradley R. Davis

  5. Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Brent D. Matthews

Authors
  1. Ryan C. Pickens
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  2. Allyson R. Cochran
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  3. William B. Lyman
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  4. Lacey King
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  5. David A. Iannitti
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  6. John B. Martinie
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  7. Erin H. Baker
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  8. Lee M. Ocuin
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  9. Stephen B. Riggs
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  10. Bradley R. Davis
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  11. Brent D. Matthews
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  12. Dionisios Vrochides
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Correspondence to Dionisios Vrochides.

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Pickens, R.C., Cochran, A.R., Lyman, W.B. et al. Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution. World J Surg 45, 23–32 (2021). https://doi.org/10.1007/s00268-020-05765-y

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  • DOI: https://doi.org/10.1007/s00268-020-05765-y

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