The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay
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and Other Interventional Techniques
2019 SAGES ORAL
The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair Walker Ueland1 · Seth Walsh‑Blackmore1 · Michael Nisiewicz1 · Daniel L. Davenport2 · Margaret A. Plymale3 · Mary Plymale4 · John S. Roth3,5 Received: 5 April 2019 / Accepted: 28 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Ventral hernia repair (VHR) is a commonly performed procedure that may be associated with prolonged hospitalization. Enhanced recovery after surgery (ERAS) protocols are intended to decrease hospital length of stay (LOS) and improve outcomes. This study evaluated the impact of compliance with individual VHR ERAS elements on LOS. Methods With IRB approval, a medical record review (perioperative characteristics, clinical outcomes, compliance with ERAS elements) was conducted of open VHR consecutive cases performed in August 2013–July 2017. The ERAS protocol was implemented in August 2015; elements in place prior to implementation were accounted for in compliance review. Clinical predictors of LOS were determined through forward regression of log-transformed LOS. The effects of specific ERAS elements on LOS were assessed by adding them to the model in the presence of the clinical predictors. Results Two-hundred and thirty-four patients underwent VHR (109 ERAS, 125 pre-ERAS). Across all patients, the mean LOS was 5.4 days (SD = 3.3). Independent perioperative predictors (P’s 90% compliance with scheduled postoperative heparin or lovenox doses. The criterion for preoperative fasting and carbohydrate treatment was supplementation with Gatorade at 4 h prior to arrival time for procedure. For perioperative fluid management, the criteria were as follows: (1) intraoperative fluids
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