Young Lee, MD, MSc, Greg Zielinski, MD, Jasmine Bhinder, BS, Victoria Agramonte, RN, MSN, Ritha Belizaire, MD, Pratibha Vemulapalli, MD, FACS. The Brooklyn Hospital Center
Introduction: The enhance recovery after surgery (ERAS) protocol was developed by incorporating evidence based medicine into patient care to improve post-operative outcomes and cost. ERAS programs envelop a set of recommendations focusing on patient education, optimal fluid management, minimal incision length, decreased used of tubes and drains, opioid sparing analgesia, and early oral intake and mobilization. Studies involving ERAS protocol in colorectal surgery have shown to decrease the hospital length of stay and overall morbidity. We report the one year outcome focusing on surgical site infections (SSI) and length of stay (LOS) after implementation of the ERAS protocol for patients undergoing elective colorectal surgery in our metropolitan community hospital.
Methods: The one year outcome of patients undergoing elective colorectal surgery under the ERAS protocol, launched in 2017, was compared to the patients who received conventional colorectal surgery perioperative care in 2016 at The Brooklyn Hospital Center. A multidisciplinary committee, including surgeons, anesthesiologist, nurses, social workers, pre-surgical testing and surgery office staff, was formed to develop a perioperative protocol based on core ERAS guidelines established by previous studies. This protocol was implemented with the goal of improving elective colorectal surgical outcomes. Specifically, the hospital length of stay and surgical site infection rates were assessed.
Results: A total of 134 patients underwent colorectal surgery from 2016 until present in 2018. Of these patients, seventy-one received conventional perioperative care and sixty-three underwent the ERAS protocol. The surgical site infection rate was 7.9% in 2016 before the start of ERAS protocol at our institution. With the implementation of the ERAS protocol in 2017, we saw a drastic reduction in surgical site infection rates to 3.4% and once we were able to demonstrate full bundle compliance, we saw a decrease to 1.6%. In addition, when comparing hospital length of stay, we demonstrated a decrease from 11 days to 4 days in the conventional perioperative care and ERAS group, respectively, while our institution implemented ERAS and adopted laparoscopic techniques.
Conclusion: Our results demonstrate that the implementation of ERAS protocol, with an emphasis on laparoscopic colon techniques, in elective colorectal surgical patients at a metropolitan community hospital was effective in improving surgical site infection rates and reducing hospital length of stay dramatically.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96083
Program Number: P345
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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