With the advent of health care reimbursement reform, hospitals are facing unprecedented pressure to reduce unwanted practice variation and costs of hospitalization. To achieve these goals in surgical care, a growing number have introduced """"""""Enhanced Recovery After Surgery"""""""" (ERAS) protocols -- multidisciplinary bundles of surgical, anesthetic, nursing, and medical care intended to reduce the physiologic stress of surgery. In studies from highly specialized centers where they were developed, ERAS protocols have achieved faster recovery and shorter length of stay after colon and rectal resections. Yet it remains unclear whether such protocols improve costs and outcomes of surgical episodes overall, or simply shift them from the hospital to outpatient setting. Further, it is unknown whether ERAS will be effective for the most vulnerable, such as older patients with multiple comorbid conditions, who account for an increasing share of major surgery and often require ancillary care services after index hospitalization. Using a mixed methods approach that capitalizes on the unique data infrastructure in the state of Michigan, with comprehensive surgical outcomes, cost and utilization data, enriched by qualitative data from patient and caregiver focus groups, this proposal will evaluate the clinical, economic, and functional outcomes of ERAS for elderly colorectal surgery patients. As the first population-based assessment of ERAS protocols for inpatient surgery, this study will have immediate impact on local and national initiatives to improve the efficiency of inpatient surgical care for older adult. The proposal also entails a detailed educational plan with training that will be essential both for successful completion of this research and toward Dr. Regenbogen's career development and transition to aging research. The project, mentorship, and educational plan will prepare the candidate to be an independent investigator and national leader in surgical quality improvement for older adults. And the findings will direct his multidisciplinary team in the design and implementation of value-driven patient-centered perioperative care practices that anticipate the needs of elderly surgical patients.

Public Health Relevance

This proposal evaluates the use of enhanced recovery protocols as a strategy to improve short-term outcomes and costs of inpatient surgery in older patients. The results will have immediate impact on efforts to design efficient, patient-centered recovery plans across disciplines, and will provide payors with a blueprint for the design of value-based care delivery for inpatient surgery. The associated educational plan will serve as a vehicle for the professional development of the candidate as he transitions to independent investigator status.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1)
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Salive, Marcel
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Regenbogen, Scott E; Cain-Nielsen, Anne H; Norton, Edward C et al. (2017) Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults. JAMA Surg 152:e170123
Regenbogen, Scott E; Shah, Nirav J; Collins, Stacey D et al. (2017) Population-based Assessment of Intraoperative Fluid Administration Practices Across Three Surgical Specialties. Ann Surg 265:930-940
Regenbogen, Scott E; Mullard, Andrew J; Peters, Nanette et al. (2016) Hospital Analgesia Practices and Patient-reported Pain After Colorectal Resection. Ann Surg 264:1044-1050