Patient outcomes and provider perceptions following implementation of a standardized perioperative care pathway for open liver resection. BJS 2016; 103: 564-571.

Results

There were no differences in patient or disease characteristics between pre‐ERAS (42 patients) and post‐ERAS (75) groups. Although mean pain scores were comparable between the two groups, patients treated within the ERAS pathway had a marked reduction in opioid use on the first 3 days after surgery compared with those treated before introduction of the pathway (all P < 0·001). Duration of hospital stay was shorter in the post‐ERAS group (median 5 (i.q.r. 4–7) days versus 6 (5–7) days in the pre‐ERAS group; P = 0·037) and there was a lower incidence of postoperative complications (1 versus 10 per cent; P = 0·036). Implementation of the ERAS pathway was associated with a 40·7 per cent decrease in laboratory costs (−US $333; −€306, exchange rate 4 January 2016) and a 21·5 per cent reduction in medical supply costs (−US $394; −€362) per patient. Although 91·0 per cent of providers endorsed the ERAS pathway, 33·8 per cent identified provider aversion to a standardized protocol as the greatest hurdle to implementation.