An "enhanced-recovery-after-surgery" (ERAS) program is a guideline-based approach to surgical management with a goal of improving patient outcomes. Individual components of the ERAS program are enhancing patient education, optimizing fluid balance, minimizing incision length and the use of tubes and drains, administering opioid-sparing analgesia, encouraging early postoperative mobility, and promptly restarting oral intake. The program has been effective in decreasing lengths of stay in large, academic hospitals but hadn't been widely tested in a community hospital setting.

A community hospital in Oregon implemented the ERAS protocol for elective colorectal resection cases as of 2011. Data on patient demographics, procedure type, intraoperative interventions, and outcomes were collected prospectively from 2011 and 2012. A retrospective review of medical records from 2009 provided baseline data for comparison.

Data from 244 patients were analyzed (68 from 2009, 96 from 2011, and 80 from 2012). Compared with patients in 2009, patients in 2011 and 2012 had lower rates of colorectal cancer (53.1% and 45%, respectively, versus 83.8%), and more procedures were performed laparoscopically (84.4% and 88.8% versus 57.4%).

The mean lengths of stay decreased by two days in 2011 and by three days in 2012 over 2009 (4.7 days and 3.7 days versus 6.7 days). Rates of readmission after 30 days didn't increase from baseline in either of the study years. The decrease in lengths of stay resulted in an estimated savings per patient of $3,202 in 2011 and $4,803 in 2012.

By 2012 the rate of ileus had decreased from 13.2% in 2009 to 2.5% and the rate of intraabdominal infection had declined from 7.4% to 2.5%. Patients also used less patient-controlled narcotic analgesia (15% versus 63.2%) and more frequently received preoperative chemical prophylaxis for deep vein thrombosis (81.3% versus 44.1%).

Given the positive outcomes observed across multiple measures in the postimplementation years, the researchers support use of the ERAS protocol in the community hospital setting.-AK

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