"Enhanced Recovery" Protocols and the Cost and Quality of Inpatient Surgery
Funding: National Institute on Aging, 2015-2020 (1 K08 AG 047252 01 A1)
Hospitals caring for elderly Medicare beneficiaries face 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 major inpatient surgery. 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 patients, especially older adults with multiple comorbid conditions, who account for an increasing share of major surgery and often require ancillary care services after index hospitalization. Capitalizing on the unique data infrastructure in the state of Michigan, with rich surgical cost, utilization, and outcomes data, this project evaluates ERAS in real-world surgical care, and assesses its clinical, economic, and functional outcomes for frail and elderly patients. Specifically, researchers will evaluate: (1) clinical outcomes of ERAS in real-world surgical practice; (2) effects of ERAS on cost and utilization across the entire surgical episode; and (3) differential effects of ERAS by age and clinical risk factors. As the first population-based assessment of ERAS protocols for inpatient surgery, this study will have immediate impact on efforts to improve efficiency of inpatient surgical care, and will provide a generalizable assessment of the viability of ERAS for value-based care delivery in US hospitals.