4.7 Article

Clinical and Economic Outcomes of Enhanced Recovery Dissemination in Michigan Hospitals

Journal

ANNALS OF SURGERY
Volume 274, Issue 2, Pages 199-205

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000004726

Keywords

colectomy; cost; enhanced recovery; quality

Categories

Funding

  1. American Society of Colon and Rectal Surgeons Career Development Award [CDG-015]
  2. National Institute on Aging [K08-AG047252, R03-AG047860]
  3. Blue Cross Blue Shield of Michigan

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The study shows that ERP can significantly reduce length of hospitalization, incidence of complications, and readmission rates after colectomy, while also reducing overall costs.
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.

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