Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, A Bldg, 3rd Floor, A395, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
Surg Endosc. 2020 Jun;34(6):2675-2681. doi: 10.1007/s00464-019-07045-w. Epub 2019 Aug 1.
Enhanced recovery after surgery (ERAS) programs have been successfully implemented in several surgical fields; however, there have been mixed results observed in bariatric surgery. Our institution implemented an enhanced recovery program with specific pre-, intra-, and post-operative protocols aimed at patients, nursing staff, and physicians. The aim of the study is to assess the effectiveness of the ERAS program.
Patients who underwent bariatric surgery prior to the implementation of the enhanced recovery program in the calendar year 2015 were compared to those who had surgery after implementation in 2017. Data for our institution was drawn from the Premier Hospital Database. Poisson and quantile regressions were used to examine the association between ERAS protocol and LOS and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-day complications and readmissions.
277 bariatric surgical procedures were performed in the pre-ERAS group, compared to 348 procedures post-ERAS. While there was a 25.6% increase in volume, there was no statistical difference between the patient populations or the type of procedure performed between the 2 years. A decrease in length of stay was observed from 2.77 days in 2015 to 1.77 days in 2017 (p < 0.001), while median cost was also cut from $11,739.03 to $9482.18 (p < 0.001). 30-day readmission rate also decreased from 7.94% to 2.86% (p = 0.011). After controlling for other factors, ERAS protocol was associated with decreased LOS (IRR 0.65, p < 0.001), cost (- $2256.88, p < 0.001), and risk of 30-day readmission (OR 0.37, p = 0.011).
The implementation of a standardized enhanced recovery program resulted in reduced length of stay, cost, and 30-day readmissions. Total costs saved were greater than $800,000 in one calendar year. This study highlights that the value of an enhanced recovery program can be observed in bariatric surgery, benefiting both patients and hospital systems.
加速康复外科（ERAS）方案已在多个外科领域成功实施，但在减重手术中观察到的结果存在差异。我们的机构实施了一项包含具体术前、术中和术后方案的增强康复方案，旨在针对患者、护理人员和医生。本研究旨在评估 ERAS 方案的有效性。
将 2015 年实施增强康复方案之前接受减重手术的患者与 2017 年实施后接受手术的患者进行比较。我们机构的数据来自 Premier Hospital Database。使用泊松和分位数回归分别检验 ERAS 方案与 LOS 和成本之间的关联。使用逻辑回归评估 ERAS 对 30 天并发症和再入院的影响。
在 ERAS 前组中进行了 277 例减重手术，而在 ERAS 后组中进行了 348 例手术。尽管手术量增加了 25.6%，但两年间患者人群或手术类型之间没有统计学差异。住院时间从 2015 年的 2.77 天减少到 2017 年的 1.77 天（p<0.001），而中位数成本也从 11739.03 美元降至 9482.18 美元（p<0.001）。30 天再入院率也从 7.94%降至 2.86%（p=0.011）。在控制其他因素后，ERAS 方案与 LOS 减少相关（IRR 0.65，p<0.001）、成本降低（-2256.88 美元，p<0.001）和 30 天再入院风险降低（OR 0.37，p=0.011）。
实施标准化增强康复方案可减少住院时间、成本和 30 天再入院率。在一个日历年内，节省的总成本超过 80 万美元。本研究强调，减重手术中可以观察到增强康复方案的价值，使患者和医院系统受益。
