• J. Am. Coll. Surg. · Feb 2025

    Multicenter Study

    Impact of Multi-Institutional Enhanced Recovery after Surgery Protocol Implementation on Elective Colorectal Surgery Outcomes.

    • Marta Antoniv, Andrei Nikiforchin, Naomi M Sell, Liliana G Bordeianou, Todd D Francone, Fraz Ahmed, Marc S Rubin, and Ronald Bleday.
    • From the Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Antoniv, Ahmed, Bleday).
    • J. Am. Coll. Surg. 2025 Feb 1; 240 (2): 158166158-166.

    BackgroundEnhanced recovery after surgery (ERAS) protocols aim to improve surgical patient outcomes, although their effectiveness may vary. This study assessed the impact of multi-institutional ERAS implementation on postoperative morbidity in patients undergoing elective colorectal surgery.Study DesignWe conducted a multicenter retrospective cohort study using the American College of Surgeons NSQIP database from 2012 to 2020. We analyzed patient outcomes before (2012 to 2014) and after (2015 to 2020) ERAS implementation across 4 hospitals. Multivariable logistic regression was used to determine the impact of ERAS program on certain outcomes.ResultsA total of 8,930 cases were analyzed: 3,573 in the pre-ERAS and 5,357 in the ERAS cohort. The ERAS cohort demonstrated significant reductions in superficial surgical site infection (SSI; 7.5% vs 2.5%, p < 0.001), deep SSI (0.6% vs 0.2%, p = 0.016), urinary tract infection (3.3% vs 1.5%, p < 0.001), pulmonary embolism (0.7% vs 0.4%, p = 0.022), deep vein thrombosis (1.4% vs 0.9%, p = 0.020), sepsis (3.0% vs 2.1%, p = 0.006), and other complications. Median length of stay decreased from 5 to 4 days (p < 0.001), and 30-day readmission rate dropped from 11.3% to 9.8% (p = 0.022). Overall, ERAS implementation was associated with a 35% decrease in the odds of all 30-day complications (odds ratio 0.65, 95% CI 0.59 to 0.73). There was no effect on 30-day (p = 0.962) or overall mortality rates (p = 0.732).ConclusionsA standardized ERAS protocol, used across multiple institutions, significantly improves elective colorectal surgery outcomes, reducing complications, length of hospital stay, and readmissions. These findings support the broader implementation of ERAS to enhance patient care and reduce healthcarecosts.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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