The Impact of the Enhanced Recovery After Surgery (ERAS) Pathway on Patients Undergoing Surgery for Soft Tissue Sarcoma (STS).
*Heather Lyu, *Lily Saadat, Monica Bertagnolli, *Jiping Wang, *Elizabeth Baldini, *Matthias Stopfukuchen-Evans, Ronald Bleday, Chandrajit Raut
Brigham and Women's Hospital, Boston, MA
Objective: Patients undergoing surgery for STS can have high morbidity rates, including wound complications, particularly after preoperative radiation therapy (RT). The ERAS program is associated with improved outcomes, including decreased wound complication rates and length of stay (LOS). We launched an ERAS program for patients undergoing surgery for STS and report early outcomes.
Setting: A high volume sarcoma center.
Patients: All patients undergoing STS surgery with intent to treat with ERAS.
Design: Patients on the ERAS protocol were compared in a case-match analysis with patients undergoing surgery without ERAS. The non-ERAS cohort was retrospectively case-matched with the prospectively collected ERAS cohort by site of surgery, surgeon, sarcoma histology and treatment with preoperative radiation therapy.
Main Outcome Measures: Wound complications, acute postoperative outcomes, discharge to a facility, and LOS.
Results: 234 STS ERAS cases (July 2015-March 2018) were matched with 237 STS non-ERAS cases performed by three surgical oncologists (January 2012-March 2018). Wound dehiscence rates were significantly lower in the ERAS cohort compared to the non-ERAS cohort (2 [0.9%] vs 31 [13.1%], p<0.001) and remained significant in the patients who received preoperative radiation (0 vs 11 [21.6%], p=0.004) and who underwent surgery for extremity STS (0 vs 6 [0.7%], p=0.04). Median LOS was significantly lower in the ERAS cohort (5 days [range 0-36] vs 6 days [range 0-67], p=0.003). Discharge to a facility was significantly reduced in the ERAS cohort (13 [5.6%] vs 31 [13.1%], p=0.008).
Conclusion: Implementation of an ERAS program was associated with improved postoperative outcomes. Reduction of wound complication rates with ERAS after preoperative RT and in extremity STS patients has important implications in oncologic treatment as it offsets the most notable morbidity of neoadjuvant RT.
Back to 2019 Abstracts