Development and Impact of an Institutional Enhanced Recovery Program on Opioid Use, Length of Stay, and Hospital Costs Within an Academic Medical Center: A Cohort Analysis of 7774 Patients

• Published in: Anesthesia and analgesia Vol. 132; no. 2; pp. 442 - 455
• Main Authors: Thiele, Robert H, Sarosiek, Bethany M, Modesitt, Susan C, McMurry, Timothy L, Tiouririne, Mohamed, Martin, Linda W, Blank, Randal S, Shilling, Ashley, Browne, James A, Bogdonoff, David L, Bauer, Todd W, Hedrick, Traci L
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.02.2021
• Subjects: Academic Medical Centers - economics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - economics; Cost Savings; Cost-Benefit Analysis; Enhanced Recovery After Surgery; Hospital Costs; Humans; Interrupted Time Series Analysis; Length of Stay - economics; Pain Management - economics; Program Development; Program Evaluation; Quality Improvement - economics; Quality Indicators, Health Care - economics; Time Factors
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000005182

BACKGROUND:Enhanced Recovery (ER) is a change management framework in which a multidisciplinary team of stakeholders utilizes evidence-based medicine to protocolize all aspects of a surgical care to allow more rapid return of function. While service-specific reports of ER adoption are common, institutional-wide adoption is complex, and reports of institution-wide ER adoption are lacking in the United States. We hypothesized that ER principles were generalizable across an institution and could be implemented across a multitude of surgical disciplines with improvements in length of stay, opioid consumption, and cost of care. METHODS:Following the establishment of a formal institutional ER program, ER was adopted in 9 distinct surgical subspecialties over 5 years at an academic medical center. We compared length of stay, opioid consumption, and total cost of care in all surgical subspecialties as a function of time using a segmented regression/interrupted time series statistical model. RESULTS:There were 7774 patients among 9 distinct surgical populations including 2155 patients in the pre-ER cohort and 5619 patients in the post-ER cohort. The introduction of an ER protocol was associated with several significant changesa reduction in length of stay in 5 of 9 specialties; reduction in opioid consumption in 8 specialties; no change or reduction in maximum patient-reported pain scores; and reduction or no change in hospital costs in all specialties. The ER program was associated with an aggregate increase in profit over the study period. CONCLUSIONS:Institution-wide efforts to adopt ER can generate significant improvements in patient care, opioid consumption, hospital capacity, and profitability within a large academic medical center.