Background: Despite international data indicating that Enhanced Recovery After Surgery (ERAS) programs, which\ncombine evidence-based perioperative strategies, expedite recovery after surgery, few centers have successfully\nadopted this approach within the U.S. We describe the implementation and efficacy of an ERAS program for\ncolorectal abdominal surgery in a tertiary teaching center in the U.S.\nMethods: We used a multi-modal and continuously evolving approach to implement an ERAS program among\nall patients undergoing colorectal abdominal surgery at a single hospital at the University of California, San\nFrancisco. 279 patients who participated in the Enhanced Recovery after Surgery program were compared to\n245 previous patients who underwent surgery prior to implementation of the program. Primary end points\nwere length of stay and readmission rates. Secondary end points included postoperative pain scores, opioid\nconsumption, postoperative nausea and vomiting, length of urinary catheterization, and time to first solid\nmeal.\nResults: ERAS decreased both median total hospital length of stay (6.4 to 4.4 days) and post-procedure length\nof stay (6.0 to 4.1 days). 30-day all-cause readmission rates decreased from 21 to 9.4 %. Pain scores improved\non postoperative day 0 (3.2 to 2.1) and day 1 (3.2 to 2.6) despite decreased opioid. Median time to first solid\nmeal decreased from 4.7 to 2.7 days and duration of urinary catheterization decreased from 74 to 46 h. Similar\nimprovements were observed in all other secondary end points.\nConclusions: These results confirm that a multidisciplinary, iterative, team-based approach is associated with a\nreduction in hospital stay and an acceleration in recovery without increasing readmission rates.
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