Clinical and economic outcomes of Enhanced Recovery Dissemin
Hospitals aiming to accelerate discharge and reduce spending after surgery are increasingly adopting perioperative enhanced recovery protocols (ERPs).

The objective was to evaluate the real-world effects of enhanced recovery protocol (ERP) dissemination on clinical and economic outcomes after colectomy.

Retrospective, population-based cohort including patients in 72 hospitals in the Michigan Surgical Quality Collaborative clinical registry (N = 13,611) and/or Michigan Value Collaborative claims registry (N = 14,800) who underwent elective colectomy. Marginal effects of ERP on clinical outcomes and risk-adjusted, price-standardized 90-day episode payments were evaluated using mixed-effects models to account for secular trends and hospital performance unrelated to ERP.

- In 24 ERP hospitals, patients with Post-ERP had a significantly shorter length of stay than those with Pre-ERP, lower incidence of complications and readmissions, and lower episode payments and post-acute care.

- In mixed-effects adjusted analyses, these effects were significantly attenuated—ERP was associated with a marginal length of stay reduction of 0.4 days, and no significant difference in complications, readmissions, or overall spending.

Conclusively, ERPs are associated with a small reduction in postoperative length of hospitalization after colectomy, without unwanted increases in readmission or post-acute care spending.