Courtney E Collins, MD, Michael Jaronczyk, MD, Vladimir P Daoud, MD, Ibrahim Daoud. St Francis Hospital; Hartford CT
Objectives: Enhanced Recovery After Surgery (ERAS) pathways have been shown to expedite discharges and lower the rate of non-surgical complications in certain surgical populations. We implemented an ERAS pathway including a transversus abdominus plane (TAP) block for patients undergoing complex ventral hernia repairs to determine if streamlining patient care would result in shorter length of stays and less narcotic requirements compared to patients in the pre-ERAS period.
Methods and Procedures: An ERAS pathway was implemented for patients undergoing complex ventral hernia repairs (trasversus abdominus release, posterior rectus sheath release, and endoscopic component separation) beginning in July 2016. Prior to the procedure, patients received a TAP block using a combination of Exparel and bupivacaine. Post-operatively patients were given standardized orders including a multi-faceted pain regimen composed of mainly non-narcotic analgesics. Early ambulation and rapid diet advancement were also emphasized. Hospital length of stay (LOS), hours requiring patient-controlled analgesia (PCA), and morphine equivalents used per day of hospital stay were compared for patients in the post-ERAS time period and patients undergoing similar procedures in the year preceding ERAS implementation.
Results: A total of 57 patients were analyzed for this study, 37 of which underwent repair after ERAS implementation. Compared to the pre-ERAS population, post-ERAS patients were similar in terms of age (mean age 61.1 for post-ERAS vs. 60.1 for pre-ERAS), gender makeup (81% vs. 80% female), and BMI (32.1 vs. 32.6 all p values >0.05). Length of stay was significantly shorter in post-ERAS patients (Table 1). Hours requiring PCA and morphine equivalents given per day were also significantly reduced in post-ERAS patients.
Conclusion: Implementation of an ERAS pathway with the inclusion of a TAP block decreased hospital stay and narcotic use for patients undergoing complex hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87086
Program Number: P351
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster