302. IMPACT OF ERAS BENCHMARK ACHIEVEMENTS AND HYBRID ROBOTIC ASSISTED ESOPHAGECTOMY ON RECOVERY AND READMISSION IN AN ERAS CENTER OVER TIME
Erik Stiles, Madison Harrison, Taha Qaraqe, Joel Sternbach, Donald Low, Michal Hubka- Gastroenterology
- General Medicine
Abstract
Background
Early recovery after surgery (ERAS) guidelines have provided an effective recovery approach for esophagectomy. Adherence to ERAS benchmarks leads to improvements in accelerated recovery over time. We evaluated differences in ERAS clinical benchmark achievements in patients undergoing hybrid robotic assisted esophagectomy (hRAMIE) and the impact on length of hospital stay (LOS). We also examined the overall performance of our ERAS program and impact of operative technique on recovery and readmissions over time.
Methods
A single-center prospective database of esophageal cancer patients was retrospectively analyzed between January 2020 and December 2022. All consecutive patients underwent hRAMIE within a standardized ERAS pathway. Impact of individual ERAS benchmark achievements on postoperative outcomes were evaluated according to LOS groups: accelerated (≤6 days, AR), targeted (7–8 days, TR), and delayed recovery (≥9 days, DR). Ability to achieve AR and readmission rates were compared with previous esophagectomy patient cohorts and institutional published data. Data were tested for normality with Shapiro–Wilk testing. Continuous variables were compared via ANOVA or Kruskal-Wallis testing. Categorical variables were compared via Fisher testing.
Results
Sixty-four patients underwent hRAMIE with a median LOS 5.5 days. AR, TR, and DR was achieved by 75.0%, 18.8%, and 6.3% patients, respectively. AR outperformed the other groups in ICU stay (p = 0.0046), transition to PO medications (p < 0.0001), and chest tube removal (p = 0.0002). Complications (48.4%) were more frequent among the TR and DR groups (p = 0.0051). 30-day readmission rate of 9.4% did not differ among the recovery groups (AR 6.2%, TR 25.0%, DR 0%, p = 0.114). 90-day mortality was 4.7% and disproportionately impacted the DR group (p = 0.0203). AR increased overtime without impacting readmission rate compared to previous cohorts in our ERAS center (Figure 1).
Conclusion
Within a common ERAS pathway at a single center, adherence to recovery benchmarks in patients undergoing hRAMIE multiplies the impact of ERAS and evolving operative technique on accelerated recovery across time. Improvements in AR can be achieved without affecting readmission rates. Routine audit of achievements of ERAS benchmarks is necessary to maintain post-esophagectomy outcomes in a time of changing health care resources.