Toward More Effective "Enhanced Recovery" Protocols for Major Surgery in Older Adults
Investigators: Scott E. Regenbogen, Raymond Yung
Funding: American Geriatrics Society, 2014-2016 (Award Ltr dtd 5/8/14)
With the advent of health care reimbursement reform, hospitals are facing unprecedented pressure to reduce unwanted practice variation and costs of hospitalization. To achieve these goals in surgical care, a growing number have introduced ?Enhanced Recovery After Surgery? (ERAS) protocols -- multidisciplinary bundles of surgical, anesthetic, nursing, and medical care intended to reduce the physiologic stress of surgery. In studies from highly specialized centers where they were developed, ERAS protocols have achieved faster recovery and shorter length of stay after colon and rectal resections. Yet it remains unclear whether such protocols improve costs and outcomes of surgical episodes overall, or simply shift them from the hospital to outpatient setting. Further, it is unknown whether ERAS will be effective for the most vulnerable, such as older patients with multiple comorbid conditions, who account for an increasing share of major surgery and often require ancillary care services after index hospitalization. Using a mixed methods approach that capitalizes on the unique data infrastructure in the state of Michigan, with comprehensive surgical outcomes, cost and utilization data, enriched by qualitative data from patient and caregiver focus groups, this proposal will evaluate the clinical, economic, and functional outcomes of ERAS for elderly colorectal surgery patients. As the first population-based assessment of ERAS protocols for inpatient surgery, this study will have immediate impact on local and national initiatives to improve the efficiency of inpatient surgical care for older adults. The proposal also entails a detailed educational plan with training that will be essential both for successful completion of this research and toward Dr. Regenbogen?s career development and transition to aging research. The project, mentorship, and educational plan will prepare the candidate to be an independent investigator and national leader in surgical quality improvement for older adults. And the findings will direct his multidisciplinary team in the design and implementation of value-driven patient-centered perioperative care practices that anticipate the needs of elderly surgical patients.