Background

ERAS is a multimodal protocol minimizing peri-operative physiological changes through multimodal analgesia and post-operative nausea/vomiting prophylaxis , blood sugar control and goal directed fluid therapy along with peri-operative optimization of co-morbidities. We evaluate the impact of ERAS on patients’ experience, surgical outcomes and healthcare costs.

Methods

A retrospective evaluation of commercial Highmark Health claims and a tertiary care center EMR for patients (>18 years old) undergoing an initial gastric bypass or sleeve (CPT: 43644, 43775) between 01/2017 - 12/2018. ERAS was implemented within a single hospital beginning 02/2018. Inpatient Press-Ganey survey scores along with demographics, clinically relevant intra-, post-operative indicators such as medication, complications, length of stay and scaled claims costs were evaluated.

Results

EMR (n=893) and claims (n=8051) data were combined resulting in 8,391 unique patients. ERAS patients (n=347) were not significantly different in age, gender, or BMI (p>0.3 for all) when compared to No ERAS (n=8044) ERAS patients experienced a decrease in length of stay (ERAS v No ERAS: 1.7(0.6) v 2.0(0.7), p<0.0001), number of nausea medications dispensed (7(6-8) v 4(3-5), p<0.0001), decrease in 30-day post-op complications (EMR: n=35 v n=50, p=0.6) including ER dehydration episodes. Inpatient Press-Ganey scores improved: hospital rating (57% to 70%). Additionally, using payer claims data , there was a 1.3x decrease in total cost for the surgery (p<0.0001).

Conclusions

Our findings reveal the implementation of a multi-modal ERAS program in Bariatric Surgery provides true value to healthcare with significant benefits at the patient, hospital, and payors level.