Enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction

Background: Pathways of enhanced recovery after surgery represent a standardized, multimodal approach to postoperative care with the goal of accelerating recovery without increasing morbidity. We hypothesized that implementation of an enhanced recovery after surgery pathway for abdominal wall reconstruction would result in a decreased duration of stay. Methods: We compared 100 historic controls to 100 consecutive patients undergoing abdominal wall reconstruction with use of a newly implemented, enhanced recovery after surgery pathway to detect a difference in duration of stay of 1 day. Groups were compared on demographics and clinical characteristics using χ², Fisher exact, Mann-Whitney U test, and 2 sample t tests as appropriate for the data. Results: There was no change in duration of stay with the enhanced recovery after surgery protocol (median 5 vs 5 days, P = .78). There was no difference in time to regular diet (median 3 vs 3 days, P = .14). There was a trend toward decreased time epidurals or patient-controlled analgesia used (median 3 vs 3 day, P = .01). There was no increase in readmission rates. In a subgroup analysis, factors associated with a duration of stay <4 days were hernia width 9.5 ± 7.2 cm (P = .009), operative time 2.5 ± 0.9 hours (P = .001), and preoperative quality-of-life scores (HerQles) 59.5 ± 11.7 (P = .008). Conclusion: Our enhanced recovery after surgery study group did not show a decrease in duration of stay. Although smaller hernia defects, lesser operative times, and better baseline quality-of-life scores were associated with shorter duration of stay, the benefits of enhanced recovery after surgery seem limited in patients with the more complex hernia repairs.