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Implementation of an Enhanced Recovery After Surgery (ERAS) Program is Associated with Improved Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Christopher Webb
  • Ryan Day
  • Cristine S. Velazco
  • Barbara A. Pockaj
  • Richard J. Gray
  • Chee-Chee Stucky
  • Tonia Young-Fadok
  • Nabil WasifEmail author
Peritoneal Surface Malignancy
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Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with increased postoperative complications and a prolonged length of stay (LOS). We report on our experience following implementation of an Enhanced Recovery After Surgery (ERAS) program for CRS and HIPEC.

Methods

Patients were divided into pre- and post-ERAS groups. Modifications in the ERAS group included routine use of transversus abdominis plane blocks, intra- and postoperative fluid restriction, and minimizing the use of narcotics, drains, and nasogastric tubes.

Results

Of a total of 130 procedures, 49 (38%) were in the pre-ERAS group and 81 (62%) were in the ERAS group. Mean LOS was reduced from 10.3 ± 8.9 days to 6.9 ± 5.0 days (p = 0.007) and the rate of grade III/IV complications was reduced from 24 to 15% (p = 0.243) following ERAS implementation. The ERAS group received less intravenous fluid during hospitalization (19.2 ± 18.7 L vs. 32.8 ± 32.5 L, p = 0.003) and used less opioids than the pre-ERAS group (median of 159.7 mg of oral morphine equivalents vs. 272.6 mg). There were no significant changes in the rates of 30-day readmission or acute kidney injury between the two groups (p = non-significant). On multivariable analyses, ERAS was significantly associated with a reduction in LOS (− 2.89 days, 95% CI − 4.84 to − 0.94) and complication rates (odds ratio 0.22, 95% CI 0.08–0.57).

Conclusions

Implementation of an ERAS program for CRS and HIPEC is associated with a reduction in overall intravenous fluids, postoperative narcotic use, complication rates, and LOS.

Notes

Funding

No dedicated funding was received for this study.

Disclosures

The authors have no financial disclosures or conflicts of interest to declare.

Supplementary material

10434_2019_7900_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Christopher Webb
    • 1
  • Ryan Day
    • 1
  • Cristine S. Velazco
    • 1
  • Barbara A. Pockaj
    • 1
  • Richard J. Gray
    • 1
  • Chee-Chee Stucky
    • 1
  • Tonia Young-Fadok
    • 2
  • Nabil Wasif
    • 1
    Email author
  1. 1.Department of Surgery, Division of Surgical OncologyMayo Clinic ArizonaPhoenixUSA
  2. 2.Department of Surgery, Division of Colorectal SurgeryMayo Clinic ArizonaPhoenixUSA

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