Association of Enhanced Recovery After Surgery Implementation and Comparative Outcomes Improvement at an Academic Medical Center.

IF 2.5 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2025-09-26 DOI:10.1002/wjs.70112

Abid Khan, Elliott R Haut, Marvin Borja, Lilly D Engineer, Michael C Grant, Deborah B Hobson, Lisa E Ishii, Jill A Marsteller, Elizabeth C Wick, Greg de Lissovoy

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引用次数: 0

Abstract

Background: Enhanced recovery after surgery (ERAS) has been hypothesized to improve surgical outcomes following colorectal surgery; however, the long-term sustainability of improvement remains unclear.

Materials and methods: A comprehensive ERAS program was implemented for patients undergoing colorectal surgery at Johns Hopkins Hospital (JHH) in 2014. This study investigated inpatient elective colorectal surgery outcomes at JHH during three two-year postimplementation periods (2014-19) relative to a two-year baseline (2012-2013) via pre-post analyses and using difference-in-differences (DID) regression comparing JHH with a national sample of > 700 hospitals participating in the National Surgical Quality Improvement Program (NSQIP). Length of stay (LOS) was evaluated using multivariable zero-truncated negative binomial regression, whereas Surgical Site Infections (SSIs) and readmission rates were analyzed using multivariable logistic regression. Analyses controlled for ASA score, procedure type, age, sex, race, and surgical approach.

Results: The study included 1851 patients at JHH and 303,175 patients from the national sample. In pre-post analyses comparing JHH from baseline (2012-2013) to the final period (2018-2019), statistically significant improvements were seen for SSIs with a 4.4% reduction (OR 0.54 and 95% CI 0.35-0.86) and for readmissions with a 5.6% reduction (OR 0.57 and 95% CI 0.39-0.85), while LOS was statistically unchanged (0.41 days reduction; IRR 0.93 and 95% CI 0.85-1.01). DID analyses showed statistical equivalence for SSIs (OR 0.80 and 95% CI 0.51-1.26), greater improvement for readmission rates at JHH (OR 0.62 and 95% CI 0.42-0.92), and lower improvement for LOS at JHH (IRR 1.17 and 95% CI 1.07-1.27).

Conclusions: ERAS implementation at JHH was associated with sustained improvement that was comparable (SSIs) or superior (readmissions) to national improvement trends over a period of 6 years (postimplementation), suggesting ERAS adoption in colorectal surgery is warranted for long-term outcomes improvement. Results were suggestive of a tradeoff between readmission rates and LOS.

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一个学术医疗中心手术后增强恢复和比较结果改善的协会。

背景：增强术后恢复（ERAS）已被假设可以改善结直肠手术后的手术结果；然而，改善的长期可持续性仍不清楚。材料和方法：2014年，在约翰霍普金斯医院（JHH）对接受结直肠手术的患者实施了一项全面的ERAS计划。本研究通过前后分析和差异中差（DID）回归，将JHH与参与国家外科质量改进计划（NSQIP）的700家医院的全国样本进行比较，调查了JHH实施后三年（2014- 2019年）与两年基线期（2012-2013年）的住院选择性结直肠手术结果。使用多变量零截断负二项回归评估住院时间（LOS），而使用多变量逻辑回归分析手术部位感染（ssi）和再入院率。分析控制了ASA评分、手术类型、年龄、性别、种族和手术入路。结果：该研究包括1851名JHH患者和303175名来自全国样本的患者。在将JHH从基线（2012-2013年）与末期（2018-2019年）进行的前后分析中，ssi的统计学显著改善，减少4.4% (OR 0.54, 95% CI 0.35-0.86)，再入院减少5.6% (OR 0.57, 95% CI 0.39-0.85)，而LOS在统计学上没有变化（减少0.41天；IRR 0.93, 95% CI 0.85-1.01）。DID分析显示ssi的统计等效（OR 0.80, 95% CI 0.51-1.26）， JHH的再入院率有较大改善（OR 0.62, 95% CI 0.42-0.92）， JHH的LOS改善较低（IRR 1.17, 95% CI 1.07-1.27）。结论：在JHH实施ERAS与6年期间（实施后）的国家改善趋势相当（ssi）或更好（再入院）的持续改善相关，表明在结直肠手术中采用ERAS是有必要的，以改善长期结果。结果提示再入院率和LOS之间的权衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.