Enhanced Recovery After Surgery: Adherence Affects Outcomes of Colorectal Surgical Patients
Primary Investigator: Tess Dailey, BSN, RN-BC
Purpose: This project evaluates the outcomes of colorectal surgical patients following the implementation of the ERAS program at a community hospital to determine the effects of adherence on LOS and opioid use. The investigator hopes to demonstrate a reduction in opioid use for acute surgical pain when utilizing the ERAS pathway.
Methods: A retrospective chart review was performed on patients who underwent standard and enhanced recovery colorectal surgeries at a community hospital in 2018. Data on LOS and opioid use (MEQ/D), were extracted from a corporate and hospital database. Independent sample t-tests and descriptive statistics were used to examine correlations among the surgical pathways, LOS, and opioid use.
Results: A total of 82 colorectal surgical patients were examined: 42 ERAS patients and 40 standard colorectal surgery patients. ERAS patients had a shorter LOS (M = 3.24 ± 1.45 vs M = 5.80 ± 3.09; p < .001) and utilized less MEQ/D (M = 7.62 ± 10.45 vs M = 41.25 ± 38.07; p < .001). Adherence with the pathway items was associated with shorter LOS; the impact on MEQ/D was mixed.
Discussion: The impact of individual pathway items on LOS and opioid use requires further investigation. Surgical prescribing culture influences the use of opioids for pain management. A reduction of opioid use should translate to fewer opioid prescriptions at discharge.
Conclusion: The ERAS pathway reduces LOS and MEQ/D compared with the standard surgical pathway. Compliance with the ERAS pathway items were correlated with shorter LOS, however the impact of compliance on MEQ/D was mixed. Preoperative carbohydrate drink administration and postoperative ambulation are areas of improvement opportunity. More research is needed to determine whether opioid use decreases upon discharge and which pathway items most significantly impact outcomes.
Major Professor: Theresa Winton, DNP, APRN-C, FNP-BC, PMHNP-BC