A Retrospective Comparison Trial Investigating Aggregate Length of Stay Post Implementation of Seven Enhanced Recovery After Surgery (ERAS) Protocols between 2015 and 2022
by
,
Rebecca N. Blumenthal
1,2,*, 
Andrew R. Locke
1,
Noah Ben-Isvy
1,
Muneeb S. Hasan
1,
Chi Wang
3,
Matthew J. Belanger
1,
Mohammed Minhaj
1,2 and
Steven B. Greenberg
1,2 
1
Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL 60201, USA
2
Department of Anesthesiology and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
3
Department of Biostatistics, Endeavor Health, Evanston, IL 60201, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(19), 5847; https://doi.org/10.3390/jcm13195847
Submission received: 30 August 2024
/
Revised: 21 September 2024
/
Accepted: 29 September 2024
/
Published: 30 September 2024
(This article belongs to the Section Anesthesiology)
Abstract
:(1) Introduction: Enhanced Recovery After Surgery (ERAS) protocols can create a cultural shift that will benefit patients by significantly reducing patient length of stay when compared to an equivalent group of surgical patients not following an ERAS protocol. (2) Methods: In this retrospective study of 2236 patients in a multi-center, community-based healthcare system, matching was performed based on a multitude of variables related to demographics, comorbidities, and surgical outcomes across seven ERAS protocols. These cohorts were then compared pre and post ERAS protocol implementation. (3) Results: ERAS protocols significantly reduced hospital length of stay from 3.0 days to 2.1 days (p <0.0001). Additional significant outcomes included reductions in opioid consumption from 40 morphine milligram equivalents (MMEs) to 20 MMEs (p <0.001) and decreased pain scores on postoperative day zero (POD 0), postoperative day one (POD 1), and postoperative day two (POD 2) when stratified into mild, moderate, and severe pain (p <0.001 on all three days). (4) Conclusions: ERAS protocols aggregately reduce hospital length of stay, pain scores, and opioid consumption.
1. Introduction
Enhanced Recovery After Surgery (ERAS) protocols are evidence-based, multidisciplinary and collaborative approaches to perioperative care that provide transformative plans for minimizing pain, reducing opioid administration, expediting patient recovery, and decreasing perioperative complications and hospital length of stay [1,2,3].
ERAS initiatives are important in providing safe care and increasing patient satisfaction in hospital systems [1,2,3]. Successful implementation involves collaboration between anesthesiology, surgery, nursing teams, and many other hospital professionals who agree upon and implement a number of perioperative interventions into an evidence-based protocol [4,5,6,7]. ERAS programs start with patient education. In the preoperative period, education targets expectations about surgery and encourages patient participation in their care [8,9]. Preoperative education also emphasizes the importance of preoperative hydration, focusing on up-to-date fasting guidelines, and describes the administration of non-opioid analgesics throughout the perioperative period [10,11,12]. Intraoperatively, providers administer multimodal non-opioid analgesics and multimodal nausea and vomiting prophylactics, maintain normothermia and euvolemia, and administer regional anesthetic blocks with local anesthetics to improve and reduce pain [11,12,13,14]. In the postoperative setting, early nutrition and mobilization, continuation of multimodal non-opioid analgesics, and early removal of drains, catheters, and tubes aid in further expeditious recovery [11,12,13].
There are numerous studies that have been published previously describing success of individual ERAS protocols in multiple surgical subspecialties both in academic and community-based practices across the United States [15,16,17,18,19,20,21,22,23]. There are also several meta-analyses published of ERAS programs in a variety of surgical subspecialties in community-based and academic institutions across the world, which suggest a reduction in length of stay, opioid use, complications, and cost [1,2,3,24,25]. However, none provide a pooled analysis from one entire community-based healthcare system.
In this retrospective study, the investigators compared the ERAS pre-implementation and post-implementation aggregate length of stay, maximum pain scores, and total opioid usage (MMEs) among seven surgical procedures. We hypothesize that in a multi-center community-based health system, the aggregate length of stay among seven surgical subspecialties would be significantly reduced after ERAS implementation. In addition, we hypothesize that the addition of these customized ERAS protocols in a community healthcare system would result in a reduction in patient pain scores and opioid usage in the postoperative period.
2. Materials and Methods
The ERAS program at Endeavor Health (a four-hospital community-based healthcare system in Chicago, IL at the time of the study) was created between 2016 and 2021 and involved seven unique ERAS protocols: colorectal, ventral hernia, implant-based mastectomy, Cesarean section, open abdominal hysterectomy, prostatectomy, and hepatobiliary surgeries. This study received Endeavor Health Institutional Review Board approval, and written informed consent was waived, given the retrospective design.
The Endeavor Health ERAS protocols have three distinct phases during the perioperative period: preoperative, intraoperative, and postoperative. In the preoperative phase, the main interventions include patient education and medical optimization, up-to-date preoperative fasting guidelines and carbohydrate loading, elimination of mechanical bowel preps, multimodal non-opioid analgesic premedications, and thromboembolic and antimicrobial prophylaxis. During the intraoperative phase, there is an emphasis on multimodal, non-opioid analgesics and antiemetics, regional anesthesia techniques are utilized, patients are kept normothermic and euvolemic, and drain, catheter, and nasogastric-tube usage is minimized. The postoperative components focus on early mobilization and ambulation, early nutrition, and continuation of multimodal, non-opioid analgesics.
This study includes data collected pre and post implementation for each individual ERAS protocol. The pre-ERAS cohort in this study consists of patients who underwent surgery approximately one to two years before the implementation of each individual ERAS protocol, while the ERAS cohort consists of patients in each group from July 2021 to June 2022 after all ERAS protocols were implemented (Table 1). Additionally, during the time frame of ERAS data collection, the total volume of surgical patients participating in ERAS protocols at Endeavor was at its highest. Data were derived from an electronic Endeavor Health data warehouse system that facilitated individual outcome-based study endpoints. Chart review was relied upon to validate individual outlier data points. Pre-ERAS implementation data were collected retrospectively, and ERAS data were collected prospectively at the time of enrollment in the program.
Patients were matched based on the following variables: type of surgery, age, gender, BMI, ASA class, kidney disease *, liver disease *, chronic opioid use/abuse *, chronic pain *, cardiovascular disease *, respiratory disease *, neurologic disease *, procedure time, ICU admission, return to OR on same admission, return to OR within 30 days, discharge location, and hospital readmission.
The study’s primary outcome was the comparative aggregate length of stay between the pre-ERAS and ERAS cohorts. The secondary outcomes comparing the aggregate of the two cohorts were as follows: (1) total postoperative opioid consumption in the hospital measured in morphine milligram equivalents (MMEs), (2) the proportion of patients that received no postoperative opioids, (3) maximum pain score on postoperative day 0 (POD 0), (4) maximum pain score on POD 1 (5) maximum pain score on POD 2 and (6) the number of patients who met mild pain scores (0–3/10) on postoperative days 0–2. Pain scores are recorded in the EMR by use of a numeric pain scale of 0–10.
* Pulled from the EMR based on ICD10 codes (Appendix A).
Statistical Analysis
Patient characteristics were compared between pre-ERAS and ERAS groups using Chi-square test for categorical variables and Wilcoxon rank sum test for continuous variables, and were presented as median with interquartile range. A propensity score was estimated by fitting a logistic regression model which adjusted for type of surgery, gender, age, BMI, ASA class, kidney disease *, liver disease *, chronic opioid use/abuse *, chronic pain *, cardiovascular disease *, respiratory disease *, neurologic disease *, procedure time, ICU admission, return to OR on same admission, return to OR within 30 days, discharge location, and hospital readmission. One-to-one pair matching between the two groups was performed by nearest-neighbor matching without replacement. Covariate balances before and after matching were checked by comparison of standardized mean difference (SMD). A SMD < 0.1 was considered to indicate a proper balance between the two groups. All tests were 2-tailed and p < 0.05 was considered to be statistically significant. All analyses were performed with the SAS statistical package (version 9.4, SAS Institute, Cary, NC, USA).
3. Results
This retrospective study analyzed a total of 2236 patients who underwent seven different surgical specialty cases during the time intervals of interest. A total of 798 surgical patients were included in the pre-ERAS group, a cohort of patients pooled from the year prior to implementation of each individual ERAS protocol. Additionally, a total of 1438 patients were included in the ERAS group.
After propensity score matching based on demographic and clinical characteristics, a total of 1324 patients were included in the analysis between the pre-ERAS (n = 662) and ERAS (n = 662) groups. Table 2 suggests that all demographic and clinical characteristics were not statistically significant between groups. In addition, there were no differences in discharge location or hospital readmission rates.
Table 3 outlines numerical and distributional differences in length of stay between pre-ERAS and ERAS groups. The median length of stay in the pre-ERAS group was 3.0 days compared to 2.1 days in the ERAS group (p < 0.0001). Additionally, based on distributional differences in length of stay (p < 0.0001), patients were more likely to be discharged in less than 3 days in the ERAS group when compared to pre-ERAS.
Table 4 demonstrates the ERAS group patients consumed fewer opioids in hospital compared to the pre-ERAS group, as measured by MMEs (40 vs. 20, p < 0.0001). Distributional differences in maximum pain scores were found to be statistically significant between the two groups on POD 0 (p < 0.0001), POD 1 (p < 0.0001), and POD 2 (p < 0.0001). An increased number of patients in the ERAS group experienced mild pain (0–3/10) as opposed to moderate or severe pain on POD 0 (p< 0.0001), POD 1 (p < 0.0001), and POD 2 (p< 0.0001) when compared to pre-ERAS patients. Similarly, there was a statistically significant reduction in median pain scores in the ERAS group on POD 0 (7 vs. 6, p < 0.0001), POD 1 (6 vs. 5, p < 0.0001), and POD 2 (6 vs. 5, p = 0.0004).
4. Discussion
This retrospective study demonstrates the positive impact of implementation of multiple ERAS protocols at a multi-specialty, community-based hospital system. By investigating seven surgical specialties, this study provides a comprehensive and real-life analysis of the impact of ERAS implementation in aggregate. The pooled ERAS data clearly show a statistically significant reduction in length of stay by approximately one day. This study also suggests a reduction in opioid consumption by 50% and the achievement of more patients who experienced mild pain versus moderate or severe pain on POD 0–3.
A 50% reduction in opioid consumption using the current ERAS techniques appears to be one major step in curbing the opioid-dependence epidemic. Alarmingly, approximately 7% of all surgical patients in the US develop opioid dependence after surgery [26]. Research also suggests that patients who have high requirement for opioids as an inpatient utilize large quantities of opioids after discharge as well [27]. Because of improved perioperative pain techniques, opioid usage was minimized with multiple ERAS protocol implementations in this multi-specialty community-based hospital system. In addition, ERAS patients in this study experienced a subjective reduction in pain in the first three postoperative days, suggesting that patients’ pain was better controlled overall.
Another benefit of development of an ERAS program in multiple surgical subspecialties in a community hospital system is reduction in hospital length of stay. The one-day aggregate reduction in hospital length of stay in this study could mean millions of dollars of savings for hospitals and patients over time. According to the Kaiser Family Foundation, an average cost of a day in the hospital is approximately USD 3000 [28]. If all of the non-ERAS patients in this trial were converted into ERAS patients, we could potentially expect a cost savings of USD 1,986,000 annually. In a healthcare era where value-based care is a priority, this cost savings appears worth the upstart costs of any ERAS program among a variety of surgical specialties.
ERAS protocols have become increasingly recognized as integral components of perioperative care, aiming to enhance patient outcomes while optimizing resource utilization [29]. The primary outcomes of this study align with the broader literature on ERAS protocols, demonstrating significant reductions in hospital length of stay [30,31,32,33,34,35,36], postoperative pain [36,37,38], and opioid consumption [37,38]. These findings underscore the effectiveness of ERAS interventions in promoting enhanced recovery across diverse surgical specialties within a community hospital system setting. The observed decrease in hospital length of stay suggests a more efficient recovery process [30,32,35], minimizing the duration of inpatient care while ensuring appropriate patient analgesia. Moreover, the reduction in opioid consumption in our ERAS patients reflects the successful implementation of multimodal analgesia strategies, including non-opioid analgesics and regional blocks. This aligns with the principles of ERAS aimed at minimizing opioid-related complications and facilitating earlier mobilization and discharge [36,37,38].
While similar studies have explored the impact of ERAS protocols within individual surgical subspecialties in both academic and community-based medical systems [4,6,7,9,14,15,16,17,18,19,20,21,22,23,24,25,29,30,31,32,33,34,35,36,37,38], this study stands out for its focus on the impact of multiple ERAS protocols in a multi-specialty community hospital setting. The aggregate reduction in hospital length of stay, along with the significant reduction in total opioid consumption (MMEs) demonstrates the success that can be achieved by developing and implementing an ERAS program at a community-based hospital system. The consistent reduction in hospital length of stay, opioid consumption, and maximum pain scores on POD 0, POD 1, and POD 2 observed across different surgical specialties reaffirms the effectiveness of ERAS principles in various patient populations and procedures. The implications of this study extend beyond the specific context of the investigated community hospital system, emphasizing the broader applicability of ERAS protocols across various healthcare settings and surgical disciplines. The observed benefits in terms of reduced length of stay, postoperative pain, and opioid consumption underscore the potential for ERAS to enhance resource utilization [29], improve patient outcomes, and mitigate the burden of postoperative complications in a real-world environment. By emphasizing the importance of collaborative, evidence-based perioperative care, this study advocates for the widespread adoption of ERAS protocols as routine practice, irrespective of hospital size or surgical specialty.
It is important to note that creation and rollout of ERAS protocols is a difficult and time-consuming process that presents many challenges for hospital systems. There are a number of roadblocks that may impede successful ERAS implementation, including cost restraints, resource availability, administrative support, a lack of enthusiastic ERAS champions, buy-in from all providers and patients, involved quality managers, and reliable ancillary support. At our institution, the biggest impediments during ERAS development have been resource availability, specifically the need to hire more anesthesia technicians and purchase additional ultrasound equipment to aid in regional blocks, and support from all surgical and anesthesia professionals.
Several limitations warrant consideration when interpreting the findings of this study. First, the impact of external factors such as changes in clinical practice or healthcare policies over the study period could confound the observed associations. In addition, because the data from this study were pooled from 2015 to 2022, changes in the healthcare billing model and economic factors such as inflation limit the ability to accurately assess changes in cost pre and post ERAS implementation. Furthermore, the occurrence of the COVID-19 pandemic during the study period may have introduced variables that were not accounted for in the analysis, potentially influencing perioperative care practices and outcomes. This study was performed in a community-health multiple hospital system, and, therefore, the findings may be different in other parts of the world and other healthcare settings. Lastly, the retrospective nature of the study may have led to undefined biases.
5. Conclusions
This retrospective comparison trial highlights the positive impact of ERAS protocols on patient outcomes across multiple surgical specialties within a community hospital system. Despite inherent limitations, the findings of this study contribute to the growing body of evidence supporting the widespread adoption of ERAS protocols as a recognized practice in enhancing surgical recovery and optimizing resource utilization. Understanding which interventions are the most impactful could allow a more focused design of future ERAS protocols. Finally, qualitative studies investigating patient perspectives and experiences following ERAS protocols could provide valuable insights into the patient-centered benefits of enhanced recovery initiatives.
Author Contributions
Conceptualization, R.N.B., A.R.L., M.J.B., M.M. and S.B.G.; methodology, R.N.B., A.R.L., M.J.B., M.M. and S.B.G.; validation, A.R.L. and N.B.-I.; formal analysis, C.W.; writing—original draft preparation, R.N.B., A.R.L., N.B.-I., M.S.H., C.W., M.J.B., M.M. and S.B.G.; writing—review and editing, R.N.B., A.R.L., N.B.-I., M.S.H., C.W., M.J.B., M.M. and S.B.G.; supervision, A.R.L. and S.B.G.; project administration, M.S.H. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Endeavor Health (protocol code EH23-012, approved 20 February 2023).
Informed Consent Statement
Patient consent was waived due to the retrospective nature of the research, following the conclusion of care of all involved patients.
Data Availability Statement
De-identified data can be obtained with reason and institutional approval by contacting the corresponding author.
Conflicts of Interest
The authors declare no conflicts of interest.
Appendix A
ICD 10 Codes:
Kidney
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease |
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication |
| E13.22 | Other diabetes mellitus with diabetic chronic kidney disease |
| E13.29 | Other diabetes mellitus with other diabetic kidney complication |
| I12.0 | Hypertensive chronic kidney disease with stage 5 chronic kidney disease or ESRD |
| I12.9 | Hypertensive chronic kidney disease with stage 1-4/unspecified chronic kidney |
| I13.0 | Hypertensive heart and chronic kidney disease with heart failure and stage 1-4/unspecified chronic kidney |
| I13.10 | Hypertensive heart and chronic kidney disease without heart failure, with stage 1-4/unspecified chronic kidney |
| I13.11 | Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney/ESRD |
| I13.2 | Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney/ESRD |
| I15.0 | Renovascular hypertension |
| I15.1 | Hypertension secondary to other renal disorders |
| I75.81 | Atheroembolism of kidney |
| N17.0 | Acute kidney failure with tubular necrosis |
| N17.1 | Acute kidney failure with acute cortical necrosis |
| N17.2 | Acute kidney failure with medullary necrosis |
| N17.8 | Other acute kidney failure |
| N17.9 | Acute kidney failure, unspecified |
| N18.1 | Chronic kidney disease, stage 1 |
| N18.2 | Chronic kidney disease, stage 2 (mild) |
| N18.3 | Chronic kidney disease, stage 3 (moderate) |
| N18.30 | Chronic kidney disease, stage 3 unspecified |
| N18.31 | Chronic kidney disease, stage 3a |
| N18.32 | Chronic kidney disease, stage 3b |
| N18.4 | Chronic kidney disease, stage 4 (severe) |
| N18.5 | Chronic kidney disease, stage 5 |
| N18.6 | End-stage renal disease |
| N18.9 | Chronic kidney disease, unspecified |
| N19 | Unspecified kidney failure |
| N26.1 | Atrophy of kidney (terminal) |
| N26.2 | Page kidney |
| N26.9 | Renal sclerosis, unspecified |
| N27.0 | Small kidney, unilateral |
| N27.1 | Small kidney, bilateral |
| N27.9 | Small kidney, unspecified |
| N28.0 | Ischemia and infarction of kidney |
| N28.1 | Cyst of kidney, acquired |
| N28.81 | Hypertrophy of kidney |
| N28.89 | Other specified disorders of kidney and ureter |
| N28.9 | Disorder of kidney and ureter, unspecified |
| N29 | Other disorders of kidney and ureter in diseases classified elsewhere |
| N99.0 | Postprocedural (acute) (chronic) kidney failure |
| O10.211 | Pre-existing hypertensive chronic kidney disease comp pregnancy, first trimester |
| O10.212 | Pre-existing hypertensive chronic kidney disease comp pregnancy, second trimester |
| O10.213 | Pre-existing hypertensive chronic kidney disease comp pregnancy, third trimester |
| O10.219 | Pre-existing hypertensive chronic kidney disease comp pregnancy, unspecified trimester |
| O10.22 | Pre-existing hypertensive chronic kidney disease comp childbirth |
| O10.23 | Pre-existing hypertensive chronic kidney disease comp the puerperium |
| O10.311 | Pre-existing hypertensive heart and chronic kidney disease comp pregnancy, first trimester |
| O10.312 | Pre-existing hypertensive heart and chr kidney dis comp pregnancy, second trimester |
| O10.313 | Pre-existing hypertensive heart and chr kidney dis comp pregnancy, third trimester |
| O10.319 | Pre-existing hypertensive heart and chr kidney dis comp pregnancy, unspecified trimester |
| O10.32 | Pre-existing hypertensive heart and chronic kidney disease comp childbirth |
| O10.33 | Pre-existing hypertensive heart and chr kidney disease complicating the puerperium |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O86.21 | Infection of kidney following delivery |
| O90.4 | Postpartum acute kidney failure |
| Q61.2 | Polycystic kidney, adult type |
| Q61.3 | Polycystic kidney, unspecified |
| Q61.5 | Medullary cystic kidney |
| Q61.8 | Other cystic kidney diseases |
| Q61.9 | Cystic kidney disease, unspecified |
| R94.4 | Abnormal results of kidney function studies |
| S3.7001A | Unspecified injury of right kidney, initial encounter |
| S37.001D | Unspecified injury of right kidney, subsequent encounter |
| S37.001S | Unspecified injury of right kidney, sequela |
| S37.002A | Unspecified injury of left kidney, initial encounter |
| S37.002D | Unspecified injury of left kidney, subsequent encounter |
| S37.002S | Unspecified injury of left kidney, sequela |
| S37.009A | Unspecified injury of unspecified kidney, initial encounter |
| S37.009D | Unspecified injury of unspecified kidney, subs encounter |
| S37.009S | Unspecified injury of unspecified kidney, sequela |
| S37.011A | Minor contusion of right kidney, initial encounter |
| S37.011D | Minor contusion of right kidney, subsequent encounter |
| S37.011S | Minor contusion of right kidney, sequela |
| S37.012A | Minor contusion of left kidney, initial encounter |
| S37.012D | Minor contusion of left kidney, subsequent encounter |
| S37.012S | Minor contusion of left kidney, sequela |
| S37.019A | Minor contusion of unspecified kidney, initial encounter |
| S37.019D | Minor contusion of unspecified kidney, subsequent encounter |
| S37.019S | Minor contusion of unspecified kidney, sequela |
| S37.021A | Major contusion of right kidney, initial encounter |
| S37.021D | Major contusion of right kidney, subsequent encounter |
| S37.021S | Major contusion of right kidney, sequela |
| S37.022A | Major contusion of left kidney, initial encounter |
| S37.022D | Major contusion of left kidney, subsequent encounter |
| S37.022S | Major contusion of left kidney, sequela |
| S37.029A | Major contusion of unspecified kidney, initial encounter |
| S37.029D | Major contusion of unspecified kidney, subsequent encounter |
| S37.029S | Major contusion of unspecified kidney, sequela |
| S37.031A | Laceration of right kidney, unspecified degree, initial encounter |
| S37.031D | Laceration of right kidney, unspecified degree, subsequent encounter |
| S37.031S | Laceration of right kidney, unspecified degree, sequela |
| S37.032A | Laceration of left kidney, unspecified degree, initial encounter |
| S37.032D | Laceration of left kidney, unspecified degree, subsequent encounter |
| S37.032S | Laceration of left kidney, unspecified degree, sequela |
| S37.039A | Laceration of unspecified kidney, unspecified degree, initial encounter |
| S37.039D | Laceration of unspecified kidney, unspecified degree, subsequent encounter |
| S37.039S | Laceration of unspecified kidney, unspecified degree, sequela |
| S37.041A | Minor laceration of right kidney, initial encounter |
| S37.041D | Minor laceration of right kidney, subsequent encounter |
| S37.041S | Minor laceration of right kidney, sequela |
| S37.042A | Minor laceration of left kidney, initial encounter |
| S37.042D | Minor laceration of left kidney, subsequent encounter |
| S37.042S | Minor laceration of left kidney, sequela |
| S37.049A | Minor laceration of unspecified kidney, initial encounter |
| S37.049D | Minor laceration of unspecified kidney, subsequent encounter |
| S37.049S | Minor laceration of unspecified kidney, sequela |
| S37.051A | Moderate laceration of right kidney, initial encounter |
| S37.051D | Moderate laceration of right kidney, subsequent encounter |
| S37.051S | Moderate laceration of right kidney, sequela |
| S37.052A | Moderate laceration of left kidney, initial encounter |
| S37.052D | Moderate laceration of left kidney, subsequent encounter |
| S37.052S | Moderate laceration of left kidney, sequela |
| S37.059A | Moderate laceration of unspecified kidney, initial encounter |
| S37.059D | Moderate laceration of unspecified kidney, subsequent encounter |
| S37.059S | Moderate laceration of unspecified kidney, sequela |
| S37.061A | Major laceration of right kidney, initial encounter |
| S37.061D | Major laceration of right kidney, subsequent encounter |
| S37.061S | Major laceration of right kidney, sequela |
| S37.062A | Major laceration of left kidney, initial encounter |
| S37.062D | Major laceration of left kidney, subsequent encounter |
| S37.062S | Major laceration of left kidney, sequela |
| S37.069A | Major laceration of unspecified kidney, initial encounter |
| S37.069D | Major laceration of unspecified kidney, subsequent encounter |
| S37.069S | Major laceration of unspecified kidney, sequela |
| S37.091A | Other injury of right kidney, initial encounter |
| S37.091D | Other injury of right kidney, subsequent encounter |
| S37.091S | Other injury of right kidney, sequela |
| S37.092A | Other injury of left kidney, initial encounter |
| S37.092D | Other injury of left kidney, subsequent encounter |
| S37.092S | Other injury of left kidney, sequela |
| S37.099A | Other injury of unspecified kidney, initial encounter |
| S37.099D | Other injury of unspecified kidney, subsequent encounter |
| S37.099S | Other injury of unspecified kidney, sequela |
| T86.10 | Unspecified complication of kidney transplant |
| T86.11 | Kidney transplant rejection |
| T86.12 | Kidney transplant failure |
| T86.13 | Kidney transplant infection |
| T86.19 | Other complication of kidney transplant |
Liver
| K70.0 | Alcoholic fatty liver |
| K70.10 | Alcoholic hepatitis without ascites |
| K70.11 | Alcoholic hepatitis with ascites |
| K70.2 | Alcoholic fibrosis and sclerosis of liver |
| K70.30 | Alcoholic cirrhosis of liver without ascites |
| K70.31 | Alcoholic cirrhosis of liver with ascites |
| K70.40 | Alcoholic hepatic failure without coma |
| K70.41 | Alcoholic hepatic failure with coma |
| K70.9 | Alcoholic liver disease, unspecified |
| K71.0 | Toxic liver disease with cholestasis |
| K71.10 | Toxic liver disease with hepatic necrosis, without coma |
| K71.11 | Toxic liver disease with hepatic necrosis, with coma |
| K71.2 | Toxic liver disease with acute hepatitis |
| K71.3 | Toxic liver disease with chronic persistent hepatitis |
| K71.4 | Toxic liver disease with chronic lobular hepatitis |
| K71.50 | Toxic liver disease with chronic active hepatitis without ascites |
| K71.51 | Toxic liver disease with chronic active hepatitis with ascites |
| K71.6 | Toxic liver disease with hepatitis, not elsewhere classified |
| K71.7 | Toxic liver disease with fibrosis and cirrhosis of liver |
| K71.8 | Toxic liver disease with other disorders of liver |
| K71.9 | Toxic liver disease, unspecified |
| K72.00 | Acute and subacute hepatic failure without coma |
| K72.01 | Acute and subacute hepatic failure with coma |
| K72.10 | Chronic hepatic failure without coma |
| K72.11 | Chronic hepatic failure with coma |
| K72.90 | Hepatic failure, unspecified without coma |
| K72.91 | Hepatic failure, unspecified with coma |
| K73.0 | Chronic persistent hepatitis, not elsewhere classified |
| K73.1 | Chronic lobular hepatitis, not elsewhere classified |
| K73.2 | Chronic active hepatitis, not elsewhere classified |
| K73.8 | Other chronic hepatitis, not elsewhere classified |
| K73.9 | Chronic hepatitis, unspecified |
| K74.60 | Unspecified cirrhosis of liver |
| K74.69 | Other cirrhosis of liver |
| K75.0 | Abscess of liver |
| K75.89 | Other specified inflammatory liver diseases |
| K75.9 | Inflammatory liver disease, unspecified |
| K76.0 | Fatty (change of) liver, not elsewhere classified |
| K76.1 | Chronic passive congestion of liver |
| K76.2 | Central hemorrhagic necrosis of liver |
| K76.3 | Infarction of liver |
| K76.89 | Other specified diseases of liver |
| K76.9 | Liver disease, unspecified |
| K77 | Liver disorders in diseases classified elsewhere |
| O26.611 | Liver and biliary tract disorders in pregnancy, first trimester |
| O26.612 | Liver and biliary tract disorders in pregnancy, second trimester |
| O26.613 | Liver and biliary tract disorders in pregnancy, third trimester |
| O26.619 | Liver and biliary tract disorders in pregnancy, unspecified trimester |
| O26.62 | Liver and biliary tract disorders in childbirth |
| O26.63 | Liver and biliary tract disorders in the puerperium |
| Q44.6 | Cystic disease of liver |
| Q44.7 | Other congenital malformations of liver |
| R94.5 | Abnormal results of liver function studies |
| S36.112A | Contusion of liver, initial encounter |
| S36.112D | Contusion of liver, subsequent encounter |
| S36.112S | Contusion of liver, sequela |
| S36.113A | Laceration of liver, unspecified degree, initial encounter |
| S36.113D | Laceration of liver, unspecified degree, subs encounter |
| S36.113S | Laceration of liver, unspecified degree, sequela |
| S36.114A | Minor laceration of liver, initial encounter |
| S36.114D | Minor laceration of liver, subsequent encounter |
| S36.114S | Minor laceration of liver, sequela |
| S36.115A | Moderate laceration of liver, initial encounter |
| S36.115D | Moderate laceration of liver, subsequent encounter |
| S36.115S | Moderate laceration of liver, sequela |
| S36.116A | Major laceration of liver, initial encounter |
| S36.116D | Major laceration of liver, subsequent encounter |
| S36.116S | Major laceration of liver, sequela |
| S36.118A | Other injury of liver, initial encounter |
| S36.118D | Other injury of liver, subsequent encounter |
| S36.118S | Other injury of liver, sequela |
| S36.119A | Unspecified injury of liver, initial encounter |
| S36.119D | Unspecified injury of liver, subsequent encounter |
| S36.119S | Unspecified injury of liver, sequela |
| T86.40 | Unspecified complication of liver transplant |
| T86.41 | Liver transplant rejection |
| T86.42 | Liver transplant failure |
| T86.43 | Liver transplant infection |
| T86.49 | Other complications of liver transplant |
Opioid Use/Abuse
| F11.10 | Opioid abuse, uncomplicated |
| F11.11 | Opioid abuse, in remission |
| F11.120 | Opioid abuse with intoxication, uncomplicated |
| F11.121 | Opioid abuse with intoxication delirium |
| F11.122 | Opioid abuse with intoxication with perceptual disturbance |
| F11.129 | Opioid abuse with intoxication, unspecified |
| F11.13 | Opioid abuse with withdrawal |
| F11.14 | Opioid abuse with opioid-induced mood disorder |
| F11.150 | Opioid abuse with opioid-induced psychotic disorder with delusions |
| F11.151 | Opioid abuse with opioid-induced psychotic disorder with hallucinations |
| F11.159 | Opioid abuse with opioid-induced psychotic disorder, unspecified |
| F11.181 | Opioid abuse with opioid-induced sexual dysfunction |
| F11.182 | Opioid abuse with opioid-induced sleep disorder |
| F11.188 | Opioid abuse with other opioid-induced disorder |
| F11.19 | Opioid abuse with unspecified opioid-induced disorder |
| F11.20 | Opioid dependence, uncomplicated |
| F11.21 | Opioid dependence, in remission |
| F11.220 | Opioid dependence with intoxication, uncomplicated |
| F11.221 | Opioid dependence with intoxication delirium |
| F11.222 | Opioid dependence with intoxication with perceptual disturbance |
| F11.229 | Opioid dependence with intoxication, unspecified |
| F11.23 | Opioid dependence with withdrawal |
| F11.24 | Opioid dependence with opioid-induced mood disorder |
| F11.250 | Opioid depend with opioid-induced psychotic disorder with delusions |
| F11.251 | Opioid depend with opioid-induced psychotic disorder with hallucinations |
| F11.259 | Opioid dependence with opioid-induced psychotic disorder, unspecified |
| F11.281 | Opioid dependence with opioid-induced sexual dysfunction |
| F11.282 | Opioid dependence with opioid-induced sleep disorder |
| F11.288 | Opioid dependence with other opioid-induced disorder |
| F11.29 | Opioid dependence with unspecified opioid-induced disorder |
| F11.90 | Opioid use, unspecified, uncomplicated |
| F1191 | Opioid use, unspecified, in remission |
| F11.920 | Opioid use, unspecified with intoxication, uncomplicated |
| F11.921 | Opioid use, unspecified with intoxication delirium |
| F11.922 | Opioid use, unspecified with intoxication with perceptual disturbance |
| F11.929 | Opioid use, unspecified with intoxication, unspecified |
| F11.93 | Opioid use, unspecified with withdrawal |
| F11.94 | Opioid use, unspecified with opioid-induced mood disorder |
| F11.950 | Opioid use, unspecified with opioid-induced psych disorder with delusions |
| F11.951 | Opioid use, unspecified with opioid-induced psych disorder with hallucinations |
| F11.959 | Opioid use, unspecified with opioid-induced psychotic disorder, unspecified |
| F11.981 | Opioid use, unspecified with opioid-induced sexual dysfunction |
| F11.982 | Opioid use, unspecified with opioid-induced sleep disorder |
| F11.988 | Opioid use, unspecified with other opioid-induced disorder |
| F11.99 | Opioid use, unspecified with unspecified opioid-induced disorder |
| T40.0X1A | Poisoning by opium, accidental (unintentional), initial encounter |
| T40.0X1D | Poisoning by opium, accidental (unintentional), subsequent encounter |
| T40.0X1S | Poisoning by opium, accidental (unintentional), sequela |
| T40.0X2A | Poisoning by opium, intentional self-harm, initial encounter |
| T40.0X2D | Poisoning by opium, intentional self-harm, subsequent encounter |
| T40.0X2S | Poisoning by opium, intentional self-harm, sequela |
| T40.0X3A | Poisoning by opium, assault, initial encounter |
| T40.0X3D | Poisoning by opium, assault, subsequent encounter |
| T40.0X3S | Poisoning by opium, assault, sequela |
| T40.0X4A | Poisoning by opium, undetermined, initial encounter |
| T40.0X4D | Poisoning by opium, undetermined, subsequent encounter |
| T40.0X4S | Poisoning by opium, undetermined, sequela |
| T40.0X5A | Adverse effect of opium, initial encounter |
| T40.0X5D | Adverse effect of opium, subsequent encounter |
| T40.0X5S | Adverse effect of opium, sequela |
| T40.0X6A | Underdosing of opium, initial encounter |
| T40.0X6D | Underdosing of opium, subsequent encounter |
| T40.0X6S | Underdosing of opium, sequela |
| T40.2X1A | Poisoning by other opioids, accidental (unintentional), initial encounter |
| T40.2X1D | Poisoning by other opioids, accidental (unintentional), subsequent encounter |
| T40.2X1S | Poisoning by other opioids, accidental, sequela |
| T40.2X2A | Poisoning by other opioids, intentional self-harm, initial encounter |
| T40.2X2D | Poisoning by other opioids, intentional self-harm, subsequent encounter |
| T40.2X2S | Poisoning by other opioids, intentional self-harm, sequela |
| T40.2X3A | Poisoning by other opioids, assault, initial encounter |
| T40.2X3D | Poisoning by other opioids, assault, subsequent encounter |
| T40.2X3S | Poisoning by other opioids, assault, sequela |
| T40.2X4A | Poisoning by other opioids, undetermined, initial encounter |
| T40.2X4D | Poisoning by other opioids, undetermined, subs encounter |
| T40.2X4S | Poisoning by other opioids, undetermined, sequela |
| T40.2X5A | Adverse effect of other opioids, initial encounter |
| T40.2X5D | Adverse effect of other opioids, subsequent encounter |
| T40.2X5S | Adverse effect of other opioids, sequela |
| T40.2X6A | Underdosing of other opioids, initial encounter |
| T40.2X6D | Underdosing of other opioids, subsequent encounter |
| T40.2X6S | Underdosing of other opioids, sequela |
Pain
| F45.41 | Pain disorder exclusively related to psychological factors |
| F45.42 | Pain disorder with related psychological factors |
| G89.0 | Central pain syndrome |
| G89.11 | Acute pain due to trauma |
| G89.18 | Other acute postprocedural pain |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm-related pain (acute) (chronic) |
| G89.4 | Chronic pain syndrome |
| G90.50 | Complex regional pain syndrome I, unspecified |
| G90.511 | Complex regional pain syndrome I of right upper limb |
| G90.512 | Complex regional pain syndrome I of left upper limb |
| G90.513 | Complex regional pain syndrome I of upper limb, bilateral |
| G90.519 | Complex regional pain syndrome I of unspecified upper limb |
| G90.521 | Complex regional pain syndrome I of right lower limb |
| G90.522 | Complex regional pain syndrome I of left lower limb |
| G90.523 | Complex regional pain syndrome I of lower limb, bilateral |
| G90.529 | Complex regional pain syndrome I of unspecified lower limb |
| G90.59 | Complex regional pain syndrome I of other specified site |
| I83.811 | Varicose veins of right lower extremity with pain |
| I83.812 | Varicose veins of left lower extremity with pain |
| I83.813 | Varicose veins of bilateral lower extremities with pain |
| I83.819 | Varicose veins of unspecified lower extremity with pain |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.541 | Pain in joints of right hand |
| M25.542 | Pain in joints of left hand |
| M25.549 | Pain in joints of unspecified hand |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M25.59 | Pain in other specified joint |
| M54.5 | Low back pain |
| M54.50 | Low back pain, unspecified |
| M54.51 | Vertebrogenic low back pain |
| M54.59 | Other low back pain |
| M54.6 | Pain in thoracic spine |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R39.82 | Chronic bladder pain |
| R52 | Pain, unspecified |
References
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Table 1.
Data Collection Time Frame.
| Protocol | Pre-ERAS Start | Pre-ERAS End | ERAS Start | ERAS End |
|---|---|---|---|---|
| Colorectal | 9/15/2015 | 9/22/2016 | 7/1/2021 | 6/30/2022 |
| Ventral Hernia | 9/30/2016 | 9/20/2017 | 7/1/2021 | 6/30/2022 |
| Mastectomy | 3/1/2017 | 2/28/2018 | 7/7/2021 | 6/30/2022 |
| Hysterectomy | 6/30/2017 | 9/4/2018 | 7/2/2021 | 6/28/2022 |
| C-Section | 10/17/2016 | 4/30/2018 | 7/1/2021 | 6/30/2022 |
| Prostatectomy | 6/25/2018 | 6/19/2019 | 7/12/2021 | 6/28/2022 |
| Hepatobiliary | 9/26/2019 | 9/23/2020 | 7/1/2021 | 6/30/2022 |
Table 2.
Cohort Demographics.
| Variable | Overall (N = 1324) | Pre-ERAS (n = 662) | ERAS (n = 662) | ||
|---|---|---|---|---|---|
| n, (Range) | Median (IQR) | Median (IQR) | Median (IQR) | p-Value | |
| Demographics | |||||
| ERAS Protocol | 0.255 | ||||
| Colorectal | 391 (29.5) | 191 (28.9) | 200 (30.2) | ||
| Ventral Hernia | 49 (3.7) | 28 (4.2) | 21 (3.2) | ||
| Implant-Based Post-Mastectomy | 103 (7.8) | 61 (9.2) | 42 (6.3) | ||
| Open Abdominal Hysterectomy | 175 (13.2) | 83 (12.5) | 92 (13.9) | ||
| C-Section | 218 (16.5) | 99 (15.0) | 119 (18.0) | ||
| Prostatectomy | 266 (20.1) | 140 (21.1) | 126 (19.0) | ||
| Hpb | 122 (9.2) | 60 (9.1) | 62 (9.4) | ||
| Patient Gender | 0.571 | ||||
| F | 822 (62.1) | 406 (61.3) | 416 (62.8) | ||
| M | 502 (37.9) | 256 (38.7) | 246 (37.2) | ||
| AGE | n =1324 | 60.0 (44.0–69.0) | 60.0 (45.0–69.0) | 60.0 (43.0–69.0) | 0.575 |
| BMI | n = 1159 | 27.2 (23.6–31.3) | 27.0 (23.5–31.0) | 27.5 (23.7–31.7) | 0.262 |
| FINAL ASA RATING | 0.253 | ||||
| 1 | 39 (3.0) | 25 (3.8) | 14 (2.1) | ||
| 2 | 842 (64.2) | 426 (64.8) | 416 (63.5) | ||
| 3 | 419 (31.9) | 200 (30.4) | 219 (33.4) | ||
| 4 | 12 (0.9) | 6 (0.9) | 6 (0.9) | ||
| Cardiovascular System Disorder | 0.748 | ||||
| No | 1144 (86.4) | 574 (86.7) | 570 (86.1) | ||
| Yes | 180 (13.6) | 88 (13.3) | 92 (13.9) | ||
| Renal System Disorder | 0.690 | ||||
| No | 1214 (91.7) | 609 (92.0) | 605 (91.4) | ||
| Yes | 110 (8.3) | 53 (8.0) | 57 (8.6) | ||
| Hepatic System Disorder | 0.822 | ||||
| No | 1240 (93.7) | 619 (93.5) | 621 (93.8) | ||
| Yes | 84 (6.3) | 43 (6.5) | 41 (6.2) | ||
| Neurological System Disorder | 0.563 | ||||
| No | 1321 (99.8) | 660 (99.7) | 661 (99.8) | ||
| Yes | 3 (0.2) | 2 (0.3) | 1 (0.2) | ||
| Opioid Use/Abuse Disorder | 0.910 | ||||
| No | 1322 (99.8) | 661 (99.8) | 661 (99.8) | ||
| Yes | 2 (0.2) | 1 (0.2) | 1 (0.2) | ||
| Pain Disorder | 0.675 | ||||
| No | 1226 (92.6) | 611 (92.3) | 615 (92.9) | ||
| Yes | 98 (7.4) | 51 (7.7) | 47 (7.1) | ||
| Respiratory System Disorder | 0.832 | ||||
| No | 1228 (92.7) | 615 (92.9) | 613 (92.6) | ||
| Yes | 96 (7.3) | 47 (7.1) | 49 (7.4) | ||
| Operative Outcomes | |||||
| Procedure Time (Minutes) | n = 1305 | 154.0 (97.0–201.0) | 153.0 (100.0–197.0) | 154.5 (93.0–205.5) | 0.789 |
| ICU Admission | 0.817 | ||||
| No | 1305 (98.6) | 653 (98.6) | 652 (98.5) | ||
| Yes | 19 (1.4) | 9 (1.4) | 10 (1.5) | ||
| Return to OR Same Admission | 0.428 | ||||
| No | 1298 (98.0) | 651 (98.3) | 647 (97.7) | ||
| Yes | 26 (2.0) | 11 (1.7) | 15 (2.3) | ||
| Return to OR within 30 days | 0.413 | ||||
| No | 1318 (99.5) | 658 (99.4) | 660 (99.7) | ||
| Yes | 6 (0.5) | 4 (0.6) | 2 (0.3) | ||
| Discharge Location | 0.727 | ||||
| Discharged With Home Health | 82 (6.2) | 40 (6.0) | 42 (6.3) | ||
| Expired | 1 (0.1) | 1 (0.2) | 0 (0) | ||
| Home Or Self Care | 1196 (90.3) | 597 (90.2) | 599 (90.5) | ||
| Hospice Med Facility | 1 (0.1) | 0 (0) | 1 (0.2) | ||
| Hospice/Home | 0 (0) | 0 (0) | 0 (0) | ||
| Intermediate Care Facility | 0 (0) | 0 (0) | 0 (0) | ||
| Iv Therapy Provider | 1 (0.1) | 1 (0.2) | 0 (0) | ||
| Left Against Medical Advice | 0 (0) | 0 (0) | 0 (0) | ||
| Nursing Home | 1 (0.1) | 0 (0) | 1 (0.2) | ||
| Rehab Facility | 2 (0.2) | 1 (0.2) | 1 (0.2) | ||
| Skilled Nursing Facility | 40 (3) | 22 (3.3) | 18 (2.7) | ||
| Hospital Readmission | 0.813 | ||||
| No | 1248 (94.3) | 625 (94.4) | 623 (94.1) | ||
| Yes | 76 (5.7) | 37 (5.6) | 39 (5.9) | ||
Table 3.
Length of Stay.
| Variable | Overall (n = 1324) | Pre-ERAS (n = 662) | ERAS (n = 662) | ||
|---|---|---|---|---|---|
| n, (Range) | Median (IQR) | Median (IQR) | Median (IQR) | p-Value | |
| Length of Stay | n = 1324 | 2.7 (1.1–3.9) | 3.0 (1.5–4.1) | 2.1 (1.1–3.2) | <0.0001 |
| 0 to 1 | 265 (20.0) | 116 (17.5) | 149 (22.5) | <0.0001 | |
| 1.1 to 3 | 567 (42.8) | 240 (36.3) | 327 (49.4) | ||
| 3.1 to 5 | 336 (25.4) | 215 (32.5) | 121 (18.3) | ||
| 5+ | 156 (11.8) | 91 (13.7) | 65 (9.8) | ||
Table 4.
Opioid Consumption and Pain Scores.
| Variable | Overall (n = 1324) | Pre-ERAS (n = 662) | ERAS (n = 662) | ||
|---|---|---|---|---|---|
| n, (Range) | Median (IQR) | Median (IQR) | Median (IQR) | p-Value | |
| Opioid Consumption (MMEs) | n = 908 | 30.0 (10.0–84.5) | 40.0 (15.0–117.5) | 20.0 (10.0–52.5) | <0.0001 |
| Max Pain Score POD 0 | n = 1215 | 7.0 (5.0–8.0) | 7.0 (5.0–8.0) | 6.0 (4.0–8.0) | <0.0001 |
| 0 to 3 | 172 (14.2) | 62 (9.8) | 110 (18.9) | <0.0001 | |
| 4 to 6 | 417 (34.3) | 208 (32.9) | 209 (35.8) | ||
| 7 to 10 | 626 (51.5) | 362 (57.3) | 264 (45.3) | ||
| Max Pain Score POD 1 | n = 1230 | 5.0 (4.0–7.0) | 6.0 (4.0–7.0) | 5.0 (3.0–7.0) | <0.0001 |
| 0 to 3 | 270 (22.0) | 109 (17.0) | 161 (27.4) | <0.0001 | |
| 4 to 6 | 522 (42.4) | 287 (44.6) | 235 (40.0) | ||
| 7 to 10 | 438 (35.6) | 247 (38.4) | 191 (32.5) | ||
| Max Pain Score POD 2 | n = 897 | 5.0 (4.0–7.0) | 6.0 (4.0–7.0) | 5.0 (3.0–7.0) | 0.0004 |
| 0 to 3 | 217 (24.2) | 88 (18.2) | 129 (31.2) | <0.0001 | |
| 4 to 6 | 387 (43.1) | 225 (46.5) | 162 (39.2) | ||
| 7 to 10 | 293 (32.7) | 171 (35.3) | 122 (29.5) | ||
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Blumenthal, R.N.; Locke, A.R.; Ben-Isvy, N.; Hasan, M.S.; Wang, C.; Belanger, M.J.; Minhaj, M.; Greenberg, S.B. A Retrospective Comparison Trial Investigating Aggregate Length of Stay Post Implementation of Seven Enhanced Recovery After Surgery (ERAS) Protocols between 2015 and 2022. J. Clin. Med. 2024, 13, 5847. https://doi.org/10.3390/jcm13195847
AMA Style
Blumenthal RN, Locke AR, Ben-Isvy N, Hasan MS, Wang C, Belanger MJ, Minhaj M, Greenberg SB. A Retrospective Comparison Trial Investigating Aggregate Length of Stay Post Implementation of Seven Enhanced Recovery After Surgery (ERAS) Protocols between 2015 and 2022. Journal of Clinical Medicine. 2024; 13(19):5847. https://doi.org/10.3390/jcm13195847
Chicago/Turabian StyleBlumenthal, Rebecca N., Andrew R. Locke, Noah Ben-Isvy, Muneeb S. Hasan, Chi Wang, Matthew J. Belanger, Mohammed Minhaj, and Steven B. Greenberg. 2024. "A Retrospective Comparison Trial Investigating Aggregate Length of Stay Post Implementation of Seven Enhanced Recovery After Surgery (ERAS) Protocols between 2015 and 2022" Journal of Clinical Medicine 13, no. 19: 5847. https://doi.org/10.3390/jcm13195847
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