The following is the summary of “Enhanced Recovery Protocols Reduce Mortality Across Eight Surgical Specialties at Academic and University-affiliated Community Hospitals” published in the January 2023 issue of Surgery by Esper, et al.
The goal of this study is to ascertain whether or not the adoption of a streamlined enterprise resource planning system (ERP) across numerous surgical specialties at different hospitals is correlated with reduced rates of both short- and long-term mortality. This study’s secondary objectives were to analyze the impact of ERP on hospital duration of stay, 30-day readmission, discharge disposition, and complications. Contextual data summaryEnhanced postoperative recovery and its many offshoots, the ERPs, have been widely used with varying degrees of success. Complex multimodal and multidisciplinary method sets are common in these protocols, making implementation difficult or varying between specialties. Few research have examined whether or whether a streamlined form of ERP applied across different types of surgery can improve patient outcomes.
A streamlined ERP was implemented in 5 academic and community hospitals within a single health system, with a focus on 7 key domains (minimally invasive surgical approach when feasible, pre-/intra-operative multimodal analgesia, postoperative multimodal analgesia, postoperative nausea and vomiting prophylaxis, early diet advancement, early ambulation, and early removal of urinary catheter). Patients who had elective procedures in the fields of orthopedics and the digestive tract (such as hip and knee replacements, hepatobiliary, colorectal, gynecological oncology, bariatric, general, and urological surgery) were included. All surgical patients who underwent treatment between 2014 and 2017 who were either treated before or after ERP installation were subjected to a retrospective case-control study that was matched on propensity scores (control population).
As a result, during the study period, a total of 9,492 patients (5,185 ERP and 4,307 controls) had ERP-eligible surgery. A total of 3,367 ERP patients and non-ERP patients were matched using similar criteria, including surgical speciality and hospital location. Patients who received ERP had a reduced risk of death both quickly and later on: The 30-day ERP was 0.2%, while the control group was 0.6% (P=0.002), the 1-year ERP was 3.9%, while the control group was 5.1% (P<0.0001), and the 2-year ERP was 6.2%, while the control group was 9.0% (P<0.0001). ERP patients spent significantly less time in the hospital than control patients did (ERP: 3.±9 3.8 days; control: 4.8 5.0 days, P<0.0001). Patients who received ERP were also less likely to be institutionalized after treatment (ERP, 11.3%; control, 14.8%, P< 0.0001). In terms of being readmitted within 30 days, no significant differences were seen. The ERP population experienced a considerable decrease in all problems (P<0.02) with the exception of venous thromboembolism. Therefore, it is clear that a streamlined enterprise resource planning system may be deployed consistently across a wide range of surgical subspecialties and institution types. Clinical outcomes, duration of stay, discharge disposition, and short- and long-term mortality are all enhanced by ERPs.