Scott E Regenbogen1,2,3, Anne H Cain-Nielsen1,2, John D Syrjamaki1,2,3, Edward C Norton2,3,4,5. 1. Department of Surgery, University of Michigan, Ann Arbor, Michigan. 2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. 3. Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan. 4. Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan. 5. Department of Economics, University of Michigan, Ann Arbor, Michigan.
Abstract
OBJECTIVE: To evaluate real-world effects of enhanced recovery protocol (ERP) dissemination on clinical and economic outcomes after colectomy. SUMMARY BACKGROUND DATA: Hospitals aiming to accelerate discharge and reduce spending after surgery are increasingly adopting perioperative ERPs. Despite their efficacy in specialty institutions, most studies have lacked adequate control groups and diverse hospital settings and have considered only in-hospital costs. There remain concerns that accelerated discharge might incur unintended consequences. METHODS: Retrospective, population-based cohort including patients in 72 hospitals in the Michigan Surgical Quality Collaborative clinical registry (N = 13,611) and/or Michigan Value Collaborative claims registry (N = 14,800) who underwent elective colectomy, 2012 to 2018. Marginal effects of ERP on clinical outcomes and risk-adjusted, price-standardized 90-day episode payments were evaluated using mixed-effects models to account for secular trends and hospital performance unrelated to ERP. RESULTS: In 24 ERP hospitals, patients Post-ERP had significantly shorter length of stay than those Pre-ERP (5.1 vs 6.5 days, P < 0.001), lower incidence of complications (14.6% vs 16.9%, P < 0.001) and readmissions (10.4% vs 11.3%, P = 0.02), and lower episode payments ($28,550 vs $31,192, P < 0.001) and postacute care ($3,384 vs $3,909, P < 0.001). In mixed-effects adjusted analyses, these effects were significantly attenuated-ERP was associated with a marginal length of stay reduction of 0.4 days (95% confidence interval 0.2-0.6 days, P = 0.001), and no significant difference in complications, readmissions, or overall spending. CONCLUSIONS: ERPs are associated with small reduction in postoperative length of hospitalization after colectomy, without unwanted increases in readmission or postacute care spending. The real-world effects across a variety of hospitals may be smaller than observed in early-adopting specialty centers.
OBJECTIVE: To evaluate real-world effects of enhanced recovery protocol (ERP) dissemination on clinical and economic outcomes after colectomy. SUMMARY BACKGROUND DATA: Hospitals aiming to accelerate discharge and reduce spending after surgery are increasingly adopting perioperative ERPs. Despite their efficacy in specialty institutions, most studies have lacked adequate control groups and diverse hospital settings and have considered only in-hospital costs. There remain concerns that accelerated discharge might incur unintended consequences. METHODS: Retrospective, population-based cohort including patients in 72 hospitals in the Michigan Surgical Quality Collaborative clinical registry (N = 13,611) and/or Michigan Value Collaborative claims registry (N = 14,800) who underwent elective colectomy, 2012 to 2018. Marginal effects of ERP on clinical outcomes and risk-adjusted, price-standardized 90-day episode payments were evaluated using mixed-effects models to account for secular trends and hospital performance unrelated to ERP. RESULTS: In 24 ERP hospitals, patients Post-ERP had significantly shorter length of stay than those Pre-ERP (5.1 vs 6.5 days, P < 0.001), lower incidence of complications (14.6% vs 16.9%, P < 0.001) and readmissions (10.4% vs 11.3%, P = 0.02), and lower episode payments ($28,550 vs $31,192, P < 0.001) and postacute care ($3,384 vs $3,909, P < 0.001). In mixed-effects adjusted analyses, these effects were significantly attenuated-ERP was associated with a marginal length of stay reduction of 0.4 days (95% confidence interval 0.2-0.6 days, P = 0.001), and no significant difference in complications, readmissions, or overall spending. CONCLUSIONS: ERPs are associated with small reduction in postoperative length of hospitalization after colectomy, without unwanted increases in readmission or postacute care spending. The real-world effects across a variety of hospitals may be smaller than observed in early-adopting specialty centers.
Authors: Massimiliano Greco; Giovanni Capretti; Luigi Beretta; Marco Gemma; Nicolò Pecorelli; Marco Braga Journal: World J Surg Date: 2014-06 Impact factor: 3.352
Authors: Kristoffer Lassen; Mattias Soop; Jonas Nygren; P Boris W Cox; Paul O Hendry; Claudia Spies; Maarten F von Meyenfeldt; Kenneth C H Fearon; Arthur Revhaug; Stig Norderval; Olle Ljungqvist; Dileep N Lobo; Cornelis H C Dejong Journal: Arch Surg Date: 2009-10
Authors: Freek Gillissen; Christiaan Hoff; José M C Maessen; Bjorn Winkens; Jitske H F A Teeuwen; Maarten F von Meyenfeldt; Cornelis H C Dejong Journal: World J Surg Date: 2013-05 Impact factor: 3.352
Authors: Julia R Berian; Kristen A Ban; Jason B Liu; Clifford Y Ko; Liane S Feldman; Julie K Thacker Journal: Ann Surg Date: 2019-03 Impact factor: 12.969
Authors: Lawrence Lee; Juan Mata; Gabriela A Ghitulescu; Marylise Boutros; Patrick Charlebois; Barry Stein; A Sender Liberman; Gerald M Fried; Nancy Morin; Franco Carli; Eric Latimer; Liane S Feldman Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: Darrell A Campbell; Michael J Englesbe; James J Kubus; Laurel R S Phillips; Charles J Shanley; Vic Velanovich; Larry R Lloyd; Max C Hutton; Wallace A Arneson; David A Share Journal: Arch Surg Date: 2010-10
Authors: Emily A Pearsall; Zahida Meghji; Kristen B Pitzul; Mary-Anne Aarts; Marg McKenzie; Robin S McLeod; Allan Okrainec Journal: Ann Surg Date: 2015-01 Impact factor: 12.969
Authors: Ellen Coeckelberghs; Kris Vanhaecht; Deborah Seys; Bianca Cox; Gabriele Bislenghi; Albert M Wolthuis; André D'Hoore Journal: Ann Surg Date: 2022-08-02 Impact factor: 13.787