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Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience

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Abstract

Background

Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system.

Methods

We compared pre- and post-guideline implementation in consecutive elective colorectal patients, ≥18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts.

Results

A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value <0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09–2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5–21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient.

Conclusion

The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.

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Grant support

The ERAS project was funded by the Partnership for Research and Innovation in the Health System (PRIHS) research grant from Alberta Innovates: Health Solutions.

Author information

Authors and Affiliations

  1. Department of Oncology, University of Calgary, Calgary, Canada

    Gregg Nelson

  2. Alberta Health Services, Alberta, Canada

    Lawrence N. Kiyang, Ellen T. Crumley, Peter Faris, Tracy Wasylak, Carlota Basualdo-Hammond & Susan McKay

  3. Institute of Health Economics, Edmonton, AB, Canada

    Anderson Chuck & Thanh Nguyen

  4. Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden

    Olle Ljungqvist

  5. Department of Medicine, University of Alberta, Edmonton, Canada

    Leah M. Gramlich

  6. Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada

    Gregg Nelson

Authors
  1. Gregg Nelson
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  2. Lawrence N. Kiyang
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  3. Ellen T. Crumley
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  4. Anderson Chuck
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  5. Thanh Nguyen
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  6. Peter Faris
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  7. Tracy Wasylak
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  8. Carlota Basualdo-Hammond
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  9. Susan McKay
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  10. Olle Ljungqvist
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  11. Leah M. Gramlich
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Corresponding author

Correspondence to Gregg Nelson.

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Conflicts of interest

Dr. Ljungqvist is the current Chairman of the ERAS Society. He founded, serves on the Board and owns stock in Encare AB that runs the ERAS Society Interactive Audit System.

Additional information

Ljungqvist and Gramlich request shared senior authorship.

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Nelson, G., Kiyang, L.N., Crumley, E.T. et al. Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience. World J Surg 40, 1092–1103 (2016). https://doi.org/10.1007/s00268-016-3472-7

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  • DOI: https://doi.org/10.1007/s00268-016-3472-7

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