Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost

Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure

A protocol that standardizes care before, during, and after colorectal operations has reduced hospital stays by more than half, reduced complications by more than one-third, and cut costs up to $11,000 per procedure, according to study results presented yesterday at the American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference.

The researchers evaluated 246 patients who underwent elective colorectal operations at Advocate Illinois Masonic Medical Center, Chicago. The standardized care protocol, known as Enhanced Recovery After Colorectal Surgery (ERACS), was created and implemented in 2015. The study authors compared results under the protocol with operations performed in 2014, before the protocol was introduced.

The goal of the study, said Deepa Bhat, MD, a second-year surgery resident and lead study author, was to determine how ERACS would impact overall outcomes for colorectal surgery patients. “We found that not only does our pathway not negatively impact their hospital length of stay, readmission rate, and complication rates, but that ERACS actually improves these outcomes,” Dr. Bhat said. “Our goal was to determine whether we could send patients home sooner after surgery without having to worry about increased complications or increased readmission rates.”

The study findings Dr. Bhat and coauthors presented showed that the typical hospital length of stay after implementation of ERACS was 2.89 days vs. 5.65 days beforehand. The researchers found that the direct variable cost was approximately $3,705 lower with the ERACS and total hospitalization costs were reduced by up to $11,000 per patient. For the institution overall, that outcome translated into a savings of around $1 million for the year.

Dr. Bhat explained how implementation of ERACS changed practices at the hospital. “Before the enhanced recovery pathway, each surgeon had their own way of doing things, such as when patients should start liquids or when they could be discharged home from the hospital,” she said. “Now, care is standardized so that every patient experiences the same pre-, intra-, and postoperative protocol, which leads to better outcomes.”

The ERACS pathway creates protocols for care before, during and after the operation. A key difference with the implementation of ERACS, Dr. Bhat said, is that patients receive more “coaching” and education. “The patient goes into surgery having a very clear idea of what they can expect, such as how their pain will be controlled, when they can start liquids, and what their expectations are for ambulation,” she said. “By making patients active participants in their own care, they tend to do better.”

After concluding the study, Advocate Illinois Masonic Medical Center adopted the ERACS pathway as standard operating procedure and is planning to develop similar treatment pathways for other surgical procedures.


Dr. Bhat’s study co-authors are fourth-year resident Tripurari Mishra, MD; Ana Bedon, MSN; Mihaela Benulescu; Jan Kaminski, MD; and Joaquin Estrada, MD.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org.