title: Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery.
abstract: Despite international data indicating that Enhanced Recovery After Surgery (ERAS) programs, which combine evidence-based perioperative strategies, expedite recovery after surgery, few centers have successfully adopted this approach within the U.S. We describe the implementation and efficacy of an ERAS program for colorectal abdominal surgery in a tertiary teaching center in the U.S.
  
  
  
  We used a multi-modal and continuously evolving approach to implement an ERAS program among all patients undergoing colorectal abdominal surgery at a single hospital at the University of California, San Francisco. 279 patients who participated in the Enhanced Recovery after Surgery program were compared to 245 previous patients who underwent surgery prior to implementation of the program. Primary end points were length of stay and readmission rates. Secondary end points included postoperative pain scores, opioid consumption, postoperative nausea and vomiting, length of urinary catheterization, and time to first solid meal.
  
  
  
  ERAS decreased both median total hospital length of stay (6.4 to 4.4 days) and post-procedure length of stay (6.0 to 4.1 days). 30-day all-cause readmission rates decreased from 21 to 9.4 %. Pain scores improved on postoperative day 0 (3.2 to 2.1) and day 1 (3.2 to 2.6) despite decreased opioid. Median time to first solid meal decreased from 4.7 to 2.7 days and duration of urinary catheterization decreased from 74 to 46 h. Similar improvements were observed in all other secondary end points.
  
  
  
  These results confirm that a multidisciplinary, iterative, team-based approach is associated with a reduction in hospital stay and an acceleration in recovery without increasing readmission rates.
authors.affiliation: Department of Surgery, University of California San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Sarin
authors.affiliation: Department of Anesthesia & Perioperative Medicine, University of California San Francisco, 505 Parnassus Ave. M917, San Francisco, CA, 94143-0624, USA.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Litonius
authors.affiliation: Department of Anesthesia & Perioperative Medicine, University of California San Francisco, 505 Parnassus Ave. M917, San Francisco, CA, 94143-0624, USA.
authors.forename: Ramana
authors.initials: R
authors.lastname: Naidu
authors.affiliation: Department of Anesthesia & Perioperative Medicine, University of California San Francisco, 505 Parnassus Ave. M917, San Francisco, CA, 94143-0624, USA.
authors.forename: C Spencer
authors.initials: CS
authors.lastname: Yost
authors.affiliation: Department of Surgery, University of California San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA.
authors.forename: Madhulika G
authors.initials: MG
authors.lastname: Varma
authors.affiliation: Department of Anesthesia & Perioperative Medicine, University of California San Francisco, 505 Parnassus Ave. M917, San Francisco, CA, 94143-0624, USA. Lee-lynn.Chen@ucsf.edu.
authors.forename: Lee-Lynn
authors.identifier: 0000-0001-6177-063X
authors.initials: LL
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology*; D010348:Patient Care Team / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014546:Urinary Catheterization / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Decreased length of stay; Enhanced recovery after colorectal surgery; Outcomes