From January 2017 to September 2018, they prospectively collected data on 21 CM’s across “pre-operative,” “intra-operative” and “postoperative” periods on 91 consecutive RCUD ERAS patients. An overall compliance (OC) score (%) was calculated for each patient. ANOVA models were utilized to evaluate the relationship between OC and both PSC and LOS. Logistic regression was used between OC and TDR. Threshold analysis evaluated a range of cut off points for OC and an optimal OC was identified that maximized favorable outcomes.
A 1% increase in individual OC resulted in a decreased PSC of $225 (p=.0002) and decreased LOS of 0.2 days (p=.0002). Threshold analysis identified an OC of 85% as the inflection point whereby all three key clinical outcomes (PSC, LOS and TDR) were improved with statistical significance (p=.0026, .0051, .0296, respectively). Mean PSC and LOS for patients with OC ≥85% v. <85% were $15,081.18 v. $19,125.86 and 5.5 days v. 8.4 days, respectively.
In conclusion, they found overall compliance ≥85% with ERAS RCUD patients was associated with decreased PSC, LOS, and TDR. Future efforts should involve validating this compliance threshold externally. While individual components were not weighted this study highlights the cost savings and importance of an ERAS auditing system to improve surgical care.
Presented by: William M. Worrilow, BA, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California