Ally Ha, MD, Carly R Richards, MD, Robert B Lim, MD, Suzanne M Gillern, MD. Tripler Army Medical Center
OBJECTIVE: Multimodal care, including Enhanced Recovery After Surgery (ERAS) pathway, is designed to achieve early recovery for patients undergoing major surgery and is the current standard of care in colorectal surgery. The individual elements that have been used to create the ERAS pathways aim to decrease morbidity and facilitate early discharge in civilian hospitals. Military Treatment Facilities (MTF) within the Department of Defense (DOD) face unique challenges not frequently encountered within the civilian health care system to include deployment disruptions and associated high turnover rates amongst hospital staff and leadership.
We aim to compare perioperative factors and postoperative outcomes between patients undergoing elective colonic surgery following an ERAS protocol in a MTF within the DOD versus civilian hospitals in the United States.
METHODS: We utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients within the Enhanced Recovery in NSQIP (ERIN) initiative who underwent elective colonic surgery between July 2014 and December 2015. Baseline patient characteristics, implementation of components of the ERAS protocol, and postoperative outcomes were recorded.
RESULTS: A total of 1,876 patients 18 years or older were identified in the ERIN collaborative, including 34 patients who were managed at a DOD MTF. Adherence to individual components of the ERAS pathway only differed slightly between the two groups with DOD patients being more likely to have received pre-admission counseling, mechanical bowel preparation, thoracic epidural anesthesia, and early mobilization. Non-DOD patients were more likely to have received preoperative clear liquids and diet advancement to solid intake on postoperative day one. Comparison between DOD and non-DOD patients showed no significant difference in length of stay (5.74 vs 5.35, respectively; p=0.447), days until return of bowel function (3.48 vs 3.28), and pain controlled on oral medications (3.45 vs 3.43 days). The rate of anastomotic leak (2.94% vs 2.03%) was also similar in both groups.
CONCLUSIONS: Despite the unique challenges that a DOD MTF faces with frequent deployments and high turnover rates amongst its staff, an ERAS pathway was successfully implemented with achievement of similar performance outcomes as civilian hospitals within the ERIN initiative. Supportive leadership, extensive communication, and embracing a team approach are essential to overcome the unique challenges in a military system.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79199
Program Number: MSS03
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium