Dustin R Cummings, MD, Petersen P Rebecca, MD, Yates B Robert, MD, Hector A Rodriguez, MD, Andrew S Wright, MD. University of Washington
INTRODUCTION: Enhanced Recovery After Surgery (ERAS) pathways have been demonstrated to improve outcomes in colorectal surgery. There is only one prior published report of outcomes following ERAS implementation in hernia surgery, which did not analyze cost. It remains unknown whether a multidisciplinary hernia ERAS pathway results in improved outcomes without increasing healthcare costs. We hypothesize that implementation of an ERAS pathway in patients undergoing ventral hernia repair (VHR) results in shorter hospitalization, decreased 30-Day readmission, and reduced direct costs.
METHODS: A hernia-specific ERAS pathway was developed by a multidisciplinary team with members from surgery, anesthesia, nursing, physical therapy, nutrition, pharmacy, and administration. Outcomes and direct costs of consecutive patients with inpatient admission after VHR were analyzed for the 1 year preceding and 18 months following ERAS implementation at 2 hospitals in a single system. Outpatient cases were excluded from this analysis. Data was extracted from hospital quality improvement datasets. Outcomes analyzed included mortality, length of stay (LOS), ICU LOS, 30-Day readmission, and direct healthcare costs.
RESULTS: A hernia-specific ERAS pathway was developed with key components being pre-operative optimization (smoking cessation, glucose control with HgbA1c<8, immunonutrition), patient education, and peri-operative management (advanced pain management, glucose control, limited fluid resuscitation, early feeding, aggressive mobilization). There were 138 cases analysed pre-implementation and 264 post-implementation. There was no mortality in either group.
CONCLUSION(S): Development and implementation of a multidisciplinary ERAS pathway for patients requiring inpatient admission following VHR results in decreased LOS without increasing 30-day readmission. Direct healthcare costs were reduced by $1,958/case, thereby saving $516,000 during the study period. Improvements were seen for both open and laparoscopic cases. Implementation of a hernia-specific ERAS pathway reduced healthcare costs and improved patient outcomes and therefore improved the value of care provided to patients with complex ventral hernias.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88299
Program Number: S124
Presentation Session: ERAS Session
Presentation Type: Podium