The Impact of Enhanced Recovery After Surgery (ERAS) Perioperative

Protocol On Cost, Length of Stay and Quality Outcomes

Akwi Aseh BSN, RN-BC, Patti Hollifield, Jessica Roberts BSN, RN, Lindsey Fehrenbacher BSN, RN, Elizabeth Mills PharmD, Kathryn Fraley, MSN, RN
David Webb, MD
Baptist Memorial Hospital-Memphis, Surgery Department

INTRODUCTION RESULTS
Figure 1.
ERAS is a multi-disciplinary perioperative care pathway, designed to achieve early Figure 2

patient recovery following a major surgery. ERAS is a paradigm shift; it involves re-
examining traditional practices, replacing them with evidence-based best practices
when necessary. More so, it is comprehensive in its scope, covering all areas of the
patient’s surgical journey. Lastly, it has been demonstrated to be patient-centered and
more holistic. It comprises of the patient’s whole journey through the surgical experience
from the patient's home, through pre-admission, pre-operation, intra-operation, post-
operation and eventually back home.

Implementation of an ERAS program has demonstrated numerous advantages

including:
▪ Significant improvements in patient satisfaction and outcomes.
▪ Reduction in cost of care. Patients generally experience faster recovery, shortened
hospital stay.
▪ Significantly fewer complications are reported compared to traditional methods.
Figure 4
The cornerstones of ERAS includes: Figure 3.

▪ Evidence-based perioperative care Average Days/Patient/Unit

▪ Multidisciplinary and multi-professional approach 7

▪ Teamwork

Average Days Per Patient
6
▪ Continuous interactive audit and reporting
5
▪ Data-driven change
▪ Readiness to make the next change 4

2
PAE Appt-Prehab  Multimodal analgesia  Multimodal opioid sparing
Intraop

 Immunonutrition shakes 5 analgesia – ordered by 1

Preop

Postop

days prior  Regional analgesia anesthesia 0

 Glycemic control • Acetaminophen, Celebrex, ICU  ‐ Average Days
Med/Surg ‐ Step Down ‐ Telemetry ‐
Average Days Average Days Average Days
 Setting pain expectations  Normovolemia Robaxin, Baseline
 Smoking/alcohol Gabapentin/Pregabalin Aug'18 ‐ Jan'19
3.68 5.88 5.36 4.68

cessation education  Normothemia • Lidocaine ERAS Cases:

2.87 5.06 4.63 5.09
Jan'19 ‐ Feb'21
 Incentive spirometer • Ketamine
teaching  Adequate antibiotic • PRN Dilaudid, Oxycodone
 Patient exercise treatment  Early Mobility Fig 1: ICU utilization reduced by 45%, Med/Surge utilization increased by 51%,
• Up in chair for 2 hours day
 Carbohydrate Loading  Maintain adequate blood of surgery. Step down utilization decreased by 67% and Telemetry utilization reduced by 49%.
• Ensure Pre-Surgery night pressure and Glucose • POD 1 onward, ambulate
before and 2-4 hours prior levels three times a day and up in
to surgery
 Skin prep
chair
 PONV prophylaxis
Fig 2: LOS reduced by 10%, Readmission reduced by 24%, Mortality reduced by
 PONV Assessment • Scheduled antiemetic first 54%, Complications reduced by 27%.
• Pre-op Zofran, aprepitant,  Early extubation and 24 hours
scopolamine evaluation at time of  Early feeding

 Multimodal Pre-op
surgery • Patient may chew gum or
hard candy for bowel
Fig 3: Fentanyl quantity/case reduced by 39%, Hydromorphone quantity/case
1)

Medications ordered by
anesthesia
stimulation reduced by 59%, Morphine quantity/case reduced by 13%
 Early lines/drain removal
• Tylenol, Celebrex,
Gabapentin/Lyrica  VTE prophylaxis
Fig 4: Overall reduction in average days per unit utilized.
 Fluid balance Estimated cost savings of $620,615.22
 Spirometer use 10X/hr

CONCLUSION
Enhanced Recovery After Surgery has improved surgical care and outcomes and decreased cost in Baptist
DATA COLLECTION Memorial Hospital-Memphis

• Total of 1056 patients who had different types of surgeries using the ERAS To date few innovations in surgery can match the cost savings from ERAS.
protocol
ERAS is not a protocol that is static. ERAS is a way of constantly updating best practice with new knowledge and
• Retrospective review of patient outcomes from January 2019 to February 2021 care plans.

• Data presented are from ERAS encountered patients only ERAS in perioperative care is a true win (patient)-win (caregiver)-win (healthcare providers) situation.

• Data presented focused on cost, length of stay and quality outcomes Modern enhanced recovery pathways should be implemented as standard of care for all major resections.