Introduction

Many centers have adapted Enhanced Recovery after Surgery (ERAS) pathways to decrease hospital length of stay (LOS) and peri-operative complications. We report the Johns Hopkins ERAS experience, specifically evaluating complication rate, LOS, 30- and 90-day readmissions, and for the first time in an ERAS cohort, cost.

Methods

ERAS protocol (Table 1) was implemented for radical cystectomy (RC) patients in November 2015. Outcomes. readmissions and cost were compared to a matched group of 54 RC patients from an 8-month period prior to the use of ERAS. Patients were excluded if indication was not for bladder cancer or if they underwent adjunct procedures. _x000D_

Results

58 consecutive ERAS patients were compared to 54 pre-ERAS patients (Table 2). Cost of index hospitalization was $30,450 in the ERAS group and $35,411 in the pre-ERAS group; readmission LOS and costs were comparable between groups. Median LOS was 5 days for the ERAS group and 8.5 days for the pre-ERAS group (p=<0.001). The pre-ERAS group had a significantly increased use of nasogastric tube (30% vs. 13.8%) and parenteral nutrition (20.4% vs. 6.9%). A trend towards increased complications occurring during index hospitalization in the pre-ERAS group was observed, although not reaching statistical significance. The ERAS group experienced a slightly higher rate of 30-day readmission, though two were for ostomy appliance issues. The most common reason for readmission was infection in both groups; there was a higher rate of GI related readmissions in the ERAS group (Figure 1).

Conclusions

Implementation of the ERAS protocol at our center resulted in significantly reduced length of hospital stay and decreased cost, with comparable rates of complication and readmission.

Funding

None