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Early outcomes of an enhanced recovery protocol for open repair of ventral hernia

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Abstract

Background

Enhanced recovery after surgery (ERAS) protocols are evidence-based quality improvement pathways reported to be associated with improved patient outcomes. The purpose of this study was to compare short-term outcomes for open ventral hernia repair (VHR) before and after implementation of an ERAS protocol.

Methods

After obtaining IRB approval, surgical databases were searched for VHR cases for two years prior and eleven months after protocol implementation for retrospective review. Groups were compared on perioperative characteristics and clinical outcomes using chi-square, Fisher’s exact, or Mann–Whitney U test, as appropriate.

Results

One hundred and seventy-one patients underwent VHR (46 patients with ERAS protocol in place and 125 historic controls). Age, gender, ASA Class, comorbidities, and smoking status were similar between the two groups. Body mass index was lower among ERAS patients (p = .038). ERAS patients had earlier return of bowel function (median 3 vs. 4 days) (p = .003) and decreased incidence of superficial surgical site infection (SSI) (7 vs. 25%) (p = .008) than controls.

Conclusion

An ERAS protocol for VHR demonstrated improved patient outcomes. A system-wide culture focused on enhanced recovery is needed to ensure improved patient outcomes.

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Authors and Affiliations

  1. Division of General Surgery, University of Kentucky, Lexington, KY, USA

    Margaret A. Plymale, Crystal Totten, Samuel P. Carmichael, Charles S. Tancula & John Scott Roth

  2. University of Kentucky College of Medicine, Lexington, KY, USA

    Evan Stearns

  3. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Daniel L. Davenport

  4. Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, C 225, Lexington, KY, 40536, USA

    John Scott Roth

Authors
  1. Evan Stearns
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  2. Margaret A. Plymale
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  3. Daniel L. Davenport
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  4. Crystal Totten
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  5. Samuel P. Carmichael
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  6. Charles S. Tancula
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  7. John Scott Roth
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Corresponding author

Correspondence to John Scott Roth.

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Disclosures

Dr. Roth is a speaker for Bard, has grants with Bard, Acelity, Gore, and MTF, and is a consultant for Acelity. Stearns, Dr. Plymale, Dr. Davenport, Dr. Totten, Dr. Carmichael, and Tancula have no conflict of interest or financial interests to disclose.

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Stearns, E., Plymale, M.A., Davenport, D.L. et al. Early outcomes of an enhanced recovery protocol for open repair of ventral hernia. Surg Endosc 32, 2914–2922 (2018). https://doi.org/10.1007/s00464-017-6004-0

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  • DOI: https://doi.org/10.1007/s00464-017-6004-0

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