Top

Surgical Endoscopy

Published in:

01-09-2020

Enhanced value with implementation of an ERAS protocol for ventral hernia repair

Authors: Chris Harryman, Margaret A. Plymale, Evan Stearns, Daniel L. Davenport, Wayne Chang, J. Scott Roth

Published in: Surgical Endoscopy | Issue 9/2020

Abstract

Background

Open ventral hernia repair (VHR) is associated with postoperative complications and hospital readmissions. A comprehensive Enhanced Recovery after Surgery (ERAS) protocol for VHR contributes to improved clinical outcomes including the rapid return of bowel function and reduced infections. The purpose of this study was to compare hospital costs for patients cared for prior to ERAS implementation with patients cared for with an ERAS protocol.

Methods

With IRB approval, clinical characteristics and postoperative outcomes data were obtained via retrospective review of consecutive VHR patients 2 years prior to and 14 months post ERAS implementation. Hospital cost data were obtained from the cost accounting system inclusive of index hospitalization. Clinical data and hospital costs were compared between groups.

Results

Data for 178 patients (127 pre-ERAS, 51 post-ERAS) were analyzed. Preoperative and operative characteristics including gender, ASA class, comorbidities, and BMI were similar between groups. ERAS patients had faster return of bowel function (p = 0.001) and decreased incidence of superficial surgical site infection (p = 0.003). Hospital length of stay did not vary significantly pre and post ERAS implementation. Inpatient pharmacy costs were increased in ERAS group ($2673 vs. $1176 p < 0.001), but total hospital costs (14,692 vs. 15,151, p = 0.538) were similar between groups.

Conclusions

Standardization of hernia care via ERAS protocol improves clinical outcomes without impacting total costs.

Fischer JP, Wes AM, Wink JD, Nelson JA, Rohrbach JI, Braslow BM, Kovach SJ (2014) Analysis of perioperative factors associated with increased cost following abdominal wall reconstruction (AWR). Hernia 18(5):617–624. https://doi.org/10.1007/s10029-014-1276-y CrossRefPubMed

Reynolds D, Davenport D, Korosec R, Roth JS (2013) Financial implications of ventral hernia repair: a hospital cost analysis. J Gastroint Surg 17:159–167. https://doi.org/10.1007/s11605-012-1999-y CrossRef

Plymale MA, Ragulojan R, Davenport DL, Roth JS (2017) Ventral and incisional hernia: the cost of comorbidities and complications. Surg Endosc 31:341–351CrossRef

Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183. https://doi.org/10.1007/s10029-011-0879-9 CrossRefPubMed

Stowers MD, Lemanu DP, Hill AG (2015) Health economics in enhanced recovery after surgery programs. Can J Anaesth 62:219–230. https://doi.org/10.1007/s12630-014-0272-0 CrossRefPubMed

Lee L, Li C, Landry T, Latimer E, Carli F, Fried GM, Feldman LS (2014) A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery. Ann Surg 259:670–676. https://doi.org/10.1097/SLA.0b013e318295fef8 CrossRefPubMed

Lemanu DP, Singh PP, Stowers MD, Hill AG (2014) A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis 16:338–346. https://doi.org/10.1111/codi.12505 CrossRefPubMed

Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, Umapathi BA, Kron IL, Sawyer RG, Hedrick TL, McMurry TL (2015) Standardization of care: impact of an enhanced recovery protocol on length of stay, complications and direct costs after colorectal surgery. J Am Coll Surg 220:430–443CrossRef

Sammour T, Zargar-Shoshtari K, Bhat A, Kahokehr A, Hill AG (2010) A programme of enhanced recovery after surgery (ERAS) is a cost-effective intervention in elective colonic surgery. N Z Med J 123:61–70PubMed

10.

Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hübner M, Schäfer M, Demartines N (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg 100:1108–1114. https://doi.org/10.1002/bjs.9184 CrossRefPubMed

11.

Stearns E, Plymale MA, Davenport DL, Totten C, Carmichael SP, Tancula CS, Roth JS (2017) Early outcomes of an enhanced recovery protocol for open repair of ventral hernia. Surg Endosc. https://doi.org/10.1007/s00464-017-6004-0(Epub ahead of print) CrossRefPubMed

12.

Majumder A, Fayezizadeh M, Neupane R, Elliott HL, Novitsky YW (2016) Benefits of multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair. J Am Coll Surg 222:1106–1115CrossRef

13.

Fayezizadeh M, Petro CC, Rosen MJ, Novitsky YW (2014) Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes. Plast Reconstr Surg 134:151S–159S. https://doi.org/10.1097/prs.0000000000000674 CrossRefPubMed

14.

Merkow RP, Ju MH, Chung JW, Hall BL, Cohen ME, Williams MV, Tsai TC, Ko CY, Bilimoria KY (2015) Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 313(5):483–495CrossRef

15.

Holihan JL, Alawadi Z, Martindale RG, Roth JS, Wray CJ, Ko TC, Kao L, Liang MK (2015) Adverse events after ventral hernia repair: the vicious cycle of complications. J Am Coll Surg 221:478–485. https://doi.org/10.1016/j.jamcollsurg.2015.04.026 CrossRefPubMed

16.

Davila DG, Parikh N, Frelich MJ, Goldblatt MI (2016) The increased cost of ventral hernia recurrence: a cost analysis. Hernia 20:811–817. https://doi.org/10.1007/s10029-016-1515-5 CrossRefPubMed

Title: Enhanced value with implementation of an ERAS protocol for ventral hernia repair
Authors: Chris Harryman
Margaret A. Plymale
Evan Stearns
Daniel L. Davenport
Wayne Chang
J. Scott Roth
Publication date: 01-09-2020
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07166-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Enhanced value with implementation of an ERAS protocol for ventral hernia repair

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2020

Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis

Per-oral endoscopic myotomy (POEM) for a sigmoid type of achalasia: short-term outcomes and changes in the esophageal angle

Too big to breathe: predictors of respiratory failure and insufficiency after open ventral hernia repair

The efficacy and safety of one-stage endoscopic treatment for ascending acute cholangitis caused by choledocholithiasis with severe comorbidities

Ambient air pollution in gastrointestinal endoscopy unit

Long-term oncologic outcomes following anastomotic leak after anterior resection for rectal cancer: does the leak severity matter?