LAUSR

BACKGROUND Enhanced recovery protocols (ERP) have the potential to streamline care and improve short-term outcomes for surgical patients. However, for patients undergoing modern iterations of complex abdominal wall reconstruction (AWR), little literature exists on the effectiveness of these protocols. METHODS In this retrospective study we reviewed our institutional experience with complex AWR over a 2-year period with one year immediately prior and one year after implementation of our ERP. Patients undergoing primarily minimally invasive complex AWR who were compliant with 11 elements of our ERP were compared to patients who received surgery prior to implementation of the protocol or did not meet these criteria. Baseline patient characteristics and patient outcomes including hospital length of stay, narcotic usage, and readmissions were compared across groups. Multivariable regression models were used to estimate the associations of our ERP protocol with outcomes adjusting for surgical approach. RESULTS Median length of stay for the overall cohort (n=132) was 3 days (IQR 1-4). Morbidity and mortality rates were 22.6% and 0.7%, respectively. ERP patients were less likely to have a complication (ERP compliant 8.7% (n=46) vs. non-ERP 30.2% (n=86), p<0.01), had a shorter median post-operative length of stay (median 1 days vs. 3 days, p<0.01), and received fewer morphine equivalents (median 30.8 mg vs. 45 mg, p<0.01). Readmission rates for ERP patients did not differ significantly vs non-ERP patients (6.5% vs. 11.8%, p=0.34). CONCLUSIONS Use of ERPs in patients undergoing complex AWR may provide benefits for both patients and hospitals.