Perioperative Impact of Widespread Implementation of an Enhanced Recovery Protocol on Short-term Outcomes in Cancer Pati
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RESEARCH COMMUNICATION
Perioperative Impact of Widespread Implementation of an Enhanced Recovery Protocol on Short-term Outcomes in Cancer Patients Allison N. Martin 1 & Taryn E. Hassinger 1 & Kevin T. Lynch 1 Traci L. Hedrick 1
1
2
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& Linda W. Martin & Susan C. Modesitt & Robert H. Thiele &
Received: 7 July 2020 / Accepted: 1 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Surgical oncology . Cancer outcomes . Enhanced recovery . Opiates
Introduction
Methods
Enhanced recovery protocols (ERP), which promote preoperative counseling and carbohydrate loading, while minimizing perioperative fluid resuscitation and opioid use, have been associated with improved outcomes after surgery. Our institution has previously reported clinical and financial benefits associated with ERP implementation in colorectal,1,2 gynecologic,3 and thoracic4 surgical patients, but sub-group analyses limited to patients who underwent tumor resection has been conducted only for colorectal patients.5,6 We investigated the impact of ERPs on patients who underwent resection of thoracic, colorectal, or gynecologic neoplasms. We hypothesized that ERPs would be associated with reduced hospital costs, decreased length of stay (LOS), and decreased perioperative mean morphine equivalents (MME).
A retrospective, pre/post study design using bivariable comparisons was utilized to examine short-term 30-day postoperative outcomes of patients ≥ 18 years of age who underwent resection of colorectal, thoracic, or gynecologic neoplasms during the study period, which was based on ERP implementation date. The pre/post study design utilizes the individual ERP implementation dates (colorectal: August 1st, 2013; thoracic: March 8th, 2016; gynecologic: March 1st, 2015) as breakpoints for analysis. The institutional ERP components have been previously described.1,2 Primary outcomes included LOS, perioperative MME, total hospital costs, and intraoperative fluid balance. Stata version 14.2 (StataCorp LP, College Station, TX) software was used for data management and statistical analysis. This study was designated as IRB exempt by the UVA HSR-IRB.
Results Presented in part at the 2018 Society of Surgical Oncology Annual Cancer Symposium, March 2-5, 2018, Chicago, IL. * Traci L. Hedrick [email protected] 1
Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA 22908-0709, USA
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Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
3
Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
The study cohort included 1759 patients (48.3% gynecologic, 20.6% thoracic, 31.0% colorectal). Colorectal patients, as the longest running ERP at our institution, were included over a 6year period, while thoracic and gynecologic patients, were included over 3- and 2-year periods, respectively. Further disease-specific patient demographic and clinical characteristics are provided (Table 1). A larger proportion of patients underwent open colorectal surgery prior t
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