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Enhanced recovery after surgery (ERAS) decreases complications and reduces length of stay in foregut surgery patients

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Abstract

Introduction

Enhanced recovery after surgery (ERAS) programs provide a framework for optimal perioperative care to improve post-operative outcomes following surgical procedures. However, there is no consensus regarding an ERAS protocol following foregut surgery. The purpose of this study was to develop an ERAS protocol for these patients and determine whether they improved outcomes.

Methods

An IRB approved prospectively maintained database was retrospectively reviewed for all patients undergoing benign minimally invasive foregut surgery from October 2018 to January 2020. All patients were entered into the ACS risk calculator to determine their predicted rate of complications and length of stay for comparison between the ERAS and control groups. Propensity matching was used to compare post-ERAS implementation to pre-ERAS implementation patients. Firth logistic and Poisson regression analysis were used to assess the rate of complications and length of stay among the different groups of patients.

Results

There were 255 patients (60 Post-ERAS, 195 Pre-ERAS) who underwent foregut operations and met inclusion criteria. ERAS was implemented, and patients were then subdivided based on those who completed ERAS (44) and those who deviated from the protocol (16). Propensity matching analysis was performed to compare the different cohorts and showed ERAS patients had 41% decreased odds of complications and 33% reduction in length of stay compared to pre-ERAS patients. Completion of the ERAS protocol resulted in even further reductions in odds of complication and length of stay compared to patients who deviated from the protocol.

Conclusions

ERAS has shown to improve perioperative outcomes, but there is limited literature supporting the use of ERAS in foregut surgery. Usage of an ERAS protocol can decrease complications and reduce the length of stay in patients.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA

    Madeline L. Rasmussen, Steven G. Leeds, Bola Aladegbami & Marc A. Ward

  2. Center for Advanced Surgery, Baylor Scott &White Health, Dallas, TX, USA

    Madeline L. Rasmussen, Steven G. Leeds, Bola Aladegbami & Marc A. Ward

  3. Texas A&M College of Medicine, Bryan, TX, USA

    Steven G. Leeds, Edward P. Whitfield, Bola Aladegbami & Marc A. Ward

  4. Research Institute, Baylor Scott & White Health, Dallas, TX, USA

    Gerald O. Ogola

Authors
  1. Madeline L. Rasmussen
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  2. Steven G. Leeds
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  4. Bola Aladegbami
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Correspondence to Marc A. Ward.

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Disclosures

Dr. Steven Leeds is a consultant for Ethicon and Boston Scientific. Dr. Marc Ward is a consultant for Boston Scientific. Drs. Madeline Rasmussen, Edward Whitfield, Bola Aladegbami, and Gerald Ogola have no conflict of interest to financial ties to disclose.

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Rasmussen, M.L., Leeds, S.G., Whitfield, E.P. et al. Enhanced recovery after surgery (ERAS) decreases complications and reduces length of stay in foregut surgery patients. Surg Endosc 37, 2842–2850 (2023). https://doi.org/10.1007/s00464-022-09806-6

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  • DOI: https://doi.org/10.1007/s00464-022-09806-6

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