Clinical Impact of an Enhanced Recovery Program for Lower Extremity Bypass.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
23 Jan 2024
23 Jan 2024
Historique:
medline:
23
1
2024
pubmed:
23
1
2024
entrez:
23
1
2024
Statut:
aheadofprint
Résumé
To determine the association of Enhanced Recovery Program (ERP) implementation with length of stay (LOS) and perioperative outcomes after lower extremity bypass (LEB). ERPs have been shown to decrease hospital LOS and improve perioperative outcomes, but their impact on patients undergoing vascular surgery remains unknown. Patients undergoing LEB who received or did not receive care under the ERP were included: pre-ERP (1/1/2016-05/13/2018) and ERP (05/14/2018-7/31/2022). Clinicopathologic characteristics and perioperative outcomes were analyzed. Of 393 patients who underwent LEB (pre-ERP, n=161 (41%); ERP, n=232 (59%)), most were male (n=254, 64.6%), white (n=236, 60%), and government-insured (n=265, 67.4%). Pre-ERP patients had higher BMI (28.8±6.0 vs. 27.4±5.7, P=0.03) and rates of diabetes (52% vs. 36%, P=0.002). ERP patients had shorter total (6 (3-13) vs. 7 (5-14) days, P=0.01) and postoperative LOS (5 (3-8) vs. 6 (4-8) days, P<0.001). Stratified by indication, postoperative LOS was shorter in ERP patients with claudication (3 vs. 5 d, P=0.01), rest pain (5 vs. 6 d, P=0.02) and tissue loss (6 vs. 7 d, P=0.03). ERP patients with rest pain also had a shorter total LOS (6 vs. 7 d, P=0.04) and lower 30-day readmission rates (32% to 17%, P=0.02). After ERP implementation, the average daily oral morphine equivalents (OMEs) decreased (median (IQR) 52.5 (26.6-105.0) vs. 44.12 (22.2-74.4), P=0.019), while the rates of direct discharge to home increased (83% vs. 69%, P=0.002). This is the largest single center cohort study evaluating ERP in LEB, showing that ERP implementation is associated with shorter LOS and improved perioperative outcomes.
Sections du résumé
OBJECTIVE
OBJECTIVE
To determine the association of Enhanced Recovery Program (ERP) implementation with length of stay (LOS) and perioperative outcomes after lower extremity bypass (LEB).
BACKGROUND
BACKGROUND
ERPs have been shown to decrease hospital LOS and improve perioperative outcomes, but their impact on patients undergoing vascular surgery remains unknown.
METHODS
METHODS
Patients undergoing LEB who received or did not receive care under the ERP were included: pre-ERP (1/1/2016-05/13/2018) and ERP (05/14/2018-7/31/2022). Clinicopathologic characteristics and perioperative outcomes were analyzed.
RESULTS
RESULTS
Of 393 patients who underwent LEB (pre-ERP, n=161 (41%); ERP, n=232 (59%)), most were male (n=254, 64.6%), white (n=236, 60%), and government-insured (n=265, 67.4%). Pre-ERP patients had higher BMI (28.8±6.0 vs. 27.4±5.7, P=0.03) and rates of diabetes (52% vs. 36%, P=0.002). ERP patients had shorter total (6 (3-13) vs. 7 (5-14) days, P=0.01) and postoperative LOS (5 (3-8) vs. 6 (4-8) days, P<0.001). Stratified by indication, postoperative LOS was shorter in ERP patients with claudication (3 vs. 5 d, P=0.01), rest pain (5 vs. 6 d, P=0.02) and tissue loss (6 vs. 7 d, P=0.03). ERP patients with rest pain also had a shorter total LOS (6 vs. 7 d, P=0.04) and lower 30-day readmission rates (32% to 17%, P=0.02). After ERP implementation, the average daily oral morphine equivalents (OMEs) decreased (median (IQR) 52.5 (26.6-105.0) vs. 44.12 (22.2-74.4), P=0.019), while the rates of direct discharge to home increased (83% vs. 69%, P=0.002).
CONCLUSIONS
CONCLUSIONS
This is the largest single center cohort study evaluating ERP in LEB, showing that ERP implementation is associated with shorter LOS and improved perioperative outcomes.
Identifiants
pubmed: 38258556
doi: 10.1097/SLA.0000000000006212
pii: 00000658-990000000-00757
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest declaration: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.