ERAS Flashcards
What is the complication rate in GI cancer surgeries?
21-45% (highest in esophagus); 1-4% death (highest in liver)
What 5 aspects do patients consider important in post-operative recovery?
o Returning to habits and routine o Regaining independence o Overcoming mental strains o Resolution of symptoms (pain, N/V) o Enjoying life
What percentage of patients are not back to their baseline grip strength 6 months post- abdominal surgery?
52%
What percentage of patients are not back to their baseline timed walk 6 months post- abdominal surgery?
39%
What percentage of patients are not back to their baseline ADL and IADLs 6 months post- abdominal surgery?
9% and 19%, respectively
Name 5 risk factors for poor recovery
o Serious complications o Physical status at baseline o Cognitive impairment o Depression o High creatinine
What is the effect of ERAS implementation on post-op complications, LOS and hospital readmissions?
Implementation of Enhanced Recovery Programs reduces postoperative complications, reduces length of stay, with no increase in hospital readmissions
What is Enhanced Recovery After Surgery (ERAS) ?
The implementation of patient-focused, standardized, evidence-based, interdisciplinary perioperative guidelines
Name 2 ways to improve value of care.
o Improve outcomes without raising costs
o Lower costs without compromising outcomes
Name 4 pre-op aspects of ERAS
- Patient activation
- Optimization/prehab
- Reduced fasting
- CHO loading
Name 5 intra-op aspects of ERAS
- MIS
- Fluid balance
- SSI prevention bundle
- Regional anesthesia nerve blocks
- PONV anaphylaxis
Name 4 post-op aspects of ERAS
- Multimodal, opioid-sparing analgesia
- Immediate nutrition and mobilization
- Minimize tubes and drains
- Daily care maps discharge criteria
Explain the implementation process in a hospital
Pathway creation (lit review, material) (6 mo) –> Hospital committee reviews and approval (10 mo) –> Personnel Training (1 mo) –> Audit and Revision (3 mo)
How did ERAS impact LOS in esophagectomy patients?
Then: 0% home by POD 7 (esophagectomy); now: 60% home by POD 7
What is patient activation?
The knowledge, skills, confidence and motivation to participate in one’s own healthcare
Which proportion of patients have low PA?
23% (about 1/4)
What is low PA associated with in terms of complications, LOS, hospital visits and ED visits?
- Associated with inc complications (OR 1.63) and inc (LOS 1.2 days), inc hospital visits (OR 3.15). inc ED visits (OR 1.64)
- No difference in readmissions (OR 1.06)
How are clinical outcomes affected by ERAS as opposed to conventional care?
Total hospitalization, median [IQR]: 7[5-9] vs 4[3-7] d*
60-d readmissions: 11 vs 13% (no difference)
60-d complications: 43 vs 40% (no difference)
Complication severity index, mean (SD): 10.7(17) vs 10.2(14)
How are postdischarge outcomes affected by ERAS as opposed to conventional care?
Lost days from work: 35(20) vs 26(18)*
Caregiver lost days from work: 5(12) vs 1.3(2.6)*
Postoperative CLSC visits: 3.7(9) vs 1.4 (4.6)*
No difference in Quality-of-Life (SF-6D)
How much money is saved by patients with ERAS?
• Institutional costs: 1,150$ less with ERP; not significant but likely d/t reduced LOS
• Health care system cost saving: 1602 less with ERP; not significant
o Includes physician remuneration, outpatient visits…
• Society cost saving (everything together)
o Time off work, caregiver time off work…
o ~ 3000$ saved per patient!
