Anne P Ehlers, MD, MPH, Judy Y Chen-Meekin, MD, Andrew S Wright, Saurabh Khandelwal, MD. University of Washington
Background: Enhanced Recovery After Surgery (ERAS) pathways are well studied in colorectal surgery patients and are increasingly applied to other surgical populations. The effectiveness of ERAS pathways on outcomes and costs for patients undergoing Roux-en-Y gastric bypass (RYGB) remains to be determined.
Methods: Single-institution retrospective study of prospectively collected administrative data for patients undergoing RYGB from July 2015-August 2018. The ERAS pathway was implemented in June 2016 and consisted of standardized pre-operative teaching; multimodal analgesia and anti-emetics in the perioperative period; early oral intake; and standardized discharge instructions. We compared outcomes for patients treated prior to ERAS implementation (July 2015-May 2016) to those treated after ERAS implementation (July 2016-August 2018). The primary outcomes were length of stay (LOS), mean direct hospital costs, and 30-day readmission rates.
Results: Of the 311 patients undergoing RYGB, 116 had surgery before ERAS implementation and 195 did after. Patients treated after ERAS implementation had a 0.8 day shorter hospital LOS (1.9 versus 2.7 days) and direct hospital costs that were $1,096 lower ($10,796 versus $11,892). The 30-day readmission rate was similar (6.2% versus 6.0%).
Conclusion: Implementation of an ERAS pathway was associated with hospital LOS that was nearly one day shorter, and cost savings of more than $1000 per patient. This resulted in 156 fewer inpatient days and more than $200,000 in direct cost savings. Despite this, there was no appreciable change in the rate of 30-day readmission. This suggests that for patients undergoing elective RYGB, ERAS pathways can increase efficiency without negatively impacting patient outcomes. In an era when patient outcomes are increasingly scrutinized while reimbursement is declining, an ERAS pathway may help streamline patient care and maximize hospital resources.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94793
Program Number: P162
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster