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Multicenter Study
. 2021 Aug 1;274(2):199-205.
doi: 10.1097/SLA.0000000000004726.

Clinical and Economic Outcomes of Enhanced Recovery Dissemination in Michigan Hospitals

Scott E Regenbogen  1   2   3 , Anne H Cain-Nielsen  1   2 , John D Syrjamaki  1   2   3 , Edward C Norton  2   3   4   5
Affiliations
Multicenter Study

Clinical and Economic Outcomes of Enhanced Recovery Dissemination in Michigan Hospitals

Scott E Regenbogen et al. Ann Surg. .

Abstract

Objective: To evaluate real-world effects of enhanced recovery protocol (ERP) dissemination on clinical and economic outcomes after colectomy.

Summary background data: Hospitals aiming to accelerate discharge and reduce spending after surgery are increasingly adopting perioperative ERPs. Despite their efficacy in specialty institutions, most studies have lacked adequate control groups and diverse hospital settings and have considered only in-hospital costs. There remain concerns that accelerated discharge might incur unintended consequences.

Methods: Retrospective, population-based cohort including patients in 72 hospitals in the Michigan Surgical Quality Collaborative clinical registry (N = 13,611) and/or Michigan Value Collaborative claims registry (N = 14,800) who underwent elective colectomy, 2012 to 2018. Marginal effects of ERP on clinical outcomes and risk-adjusted, price-standardized 90-day episode payments were evaluated using mixed-effects models to account for secular trends and hospital performance unrelated to ERP.

Results: In 24 ERP hospitals, patients Post-ERP had significantly shorter length of stay than those Pre-ERP (5.1 vs 6.5 days, P < 0.001), lower incidence of complications (14.6% vs 16.9%, P < 0.001) and readmissions (10.4% vs 11.3%, P = 0.02), and lower episode payments ($28,550 vs $31,192, P < 0.001) and postacute care ($3,384 vs $3,909, P < 0.001). In mixed-effects adjusted analyses, these effects were significantly attenuated-ERP was associated with a marginal length of stay reduction of 0.4 days (95% confidence interval 0.2-0.6 days, P = 0.001), and no significant difference in complications, readmissions, or overall spending.

Conclusions: ERPs are associated with small reduction in postoperative length of hospitalization after colectomy, without unwanted increases in readmission or postacute care spending. The real-world effects across a variety of hospitals may be smaller than observed in early-adopting specialty centers.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:
Estimated marginal effects of enhanced recovery protocols on clinical outcomes after colectomy.
Figure 2:
Figure 2:
Estimated marginal effects of enhanced recovery protocols on economic outcomes after colectomy.
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References

    1. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 2011;149:830–840. (In eng). DOI: 10.1016/j.surg.2010.11.003. - DOI - PubMed
    1. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 2009;144:961–969. (In eng). DOI: 10.1001/archsurg.2009.170. - DOI - PubMed
    1. Ronellenfitsch U What are the effects of Enhanced Recovery after Surgery (ERAS) compared with conventional recovery strategies in people undergoing colorectal surgery? Cochrane Clinical Answers 2016;DOI: 10.1002/cca.545. - DOI
    1. Zhuang C-L, Ye X-Z, Zhang X-D, Chen B-C, Yu Z. Enhanced Recovery After Surgery Programs Versus Traditional Care for Colorectal Surgery: A Meta-analysis of Randomized Controlled Trials. Diseases of the Colon & Rectum 2013;56:667–678 10.1097/DCR.0b013e3182812842. - DOI - PubMed
    1. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014;101(3):172–88. (In eng). DOI: 10.1002/bjs.9394. - DOI - PubMed

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