Samantha Kirstein, RN, DNP, CRNA

DNP Nurse Anesthesia

Evaluation of Regional Anesthesia in Hip Fracture Patients: A Retrospective Review

Project Category: Evidence Implementation  

Project Team: Samantha Kirstein, DNP, CRNA, Jereme Froehlich, DNP, CRNA, Stephen A. Flaherty, CRNA, PhD (Advisor)

Abstract

Background: Historically, colorectal surgery has been associated with significant morbidity and prolonged length of stay (LOS). Enhanced Recovery After Surgery (ERAS) protocols have demonstrated the ability to improve patient outcomes by attenuating the surgical stress response and supporting the return of physiological function. A midwestern community hospital implemented an ERAS protocol for colorectal surgery patients, but the impact of the protocol on patient outcomes has not been previously evaluated.

Methods: Retrospective data was collected from 154 colorectal surgery patients from January 2018 to March 2024. The patients were divided into non-ERAS (n = 60) and ERAS (n = 94) groups. Data was collected using existing hospital reports and manual chart review. The primary outcomes assessed were hospital LOS and 30-day readmission. Secondary outcomes also included intraoperative and postoperative opioid consumption, postoperative pain burden, and patient and provider compliance.

Results: Patients in the ERAS group had a 25% reduction in median length of stay compared to the non-ERAS group (2.28 days [IQR, 2.29-4.23] vs 3.03 [IQR, 2.29-4.23]; p = 0.006) without an increase in 30-day readmission (5 vs 10; p = 0.64). Patients in the ERAS group had a decrease in median opioid use in the total perioperative period; however, these differences did not reach statistical significance (16.60 [IQR = 10-28.73] vs 22.05 [IQR = 11.28-35.58]; p = 0.12). 

Conclusion: Implementation of the ERAS protocol led to improved patient outcomes by reducing hospital length of stay without increasing 30-day readmission rates.