(PM P29) Development of a Novel Enhanced Recovery After Surgery Protocol (ERAS) For Cytoreductive Surgery & HIPEC
Sunday, February 16, 2020
12:25 PM – 12:30 PM
Introduction: Implementation of enhanced recovery after surgery (ERAS) protocols has demonstrated significant improvements in patient outcomes and has become the standard of care in several areas, such as colorectal surgery. Patients with peritoneal malignancy who undergo cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) present a unique challenge in implementing ERAS protocols. The physiologic insult of multi-visceral resections, which can differ substantially patient to patient, and administration of HIPEC makes standardization difficult and incomparable to other general surgery procedures. Our institution sought to develop a novel ERAS protocol for patients undergoing CRS and HIPEC to improve overall patient outcomes.
Methods: Patients undergoing CRS and HIPEC from 2017-2019 were analyzed at a single institution. Using multi-disciplinary team input, an ERAS protocol was gradually developed with periodic revisions as part of a quality improvement initiative. A final ERAS pathway including pre-operative, intra-operative, and post-operative strategies was approved by all clinical parties and implemented. Patient demographics and outcomes during this time period are reported.
Results: All patients with peritoneal malignancy who underwent CRS and HIPEC from 2017-2019 (n=37) were included during the development of a comprehensive ERAS protocol. Details of the ERAS protocol at our institution were organized and condensed into the accompanying graphic. Of the 37 patients, 20 were female and the average peritoneal cancer index (PCI) was 14.5. The median length of stay was 11 days and mean days until return of bowel movement was 5.4. The 30-day mortality for the cohort was 2.7%.
Conclusion: Patients undergoing CRS and HIPEC present a challenge when attempting to standardize and improve care using ERAS strategies. This study depicts our multi-disciplinary ERAS pathway and results over a three year development and implementation span.