O44 ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS UNDERGOING COMPLEX ABDOMINAL WALL RECONSTRUCTION (AWR)

Aim Enhanced Recovery After Surgery (ERAS) is often conceptually associated with hospital length of stay (LOS), but its true purpose is the application of best science to achieve best patient outcomes. We hypothesized that the implementation of the ERAS program would improve outcomes while possibly leading to a decreased LOS. Material and Methods Prospective institutional hernia database queried for patients who underwent open AWR between 2010–2014 (pre-ERAS) and 2016-2020 (ERAS). Demographics, operative characteristics and postoperative outcomes were compared between pre-ERAS and ERAS patients. Standard descriptive statistics and logistic regression were used. Results 1713 patients were analyzed (ERAS-802, pre-ERAS-911). ERAS patients were similar in terms of age (58.9±12.1vs58.4±12.5;p=0.29) and diabetes (24.6%vs25.9%;p=0.53) compared to pre-ERAS patients, but ERAS patients had lower BMI (31.2±6.3vs33.3±8.1 kg/m2;p<0.01) and increased smoking history (35.8%vs16.1%;p<0.01). The percentage of ERAS patients with CDC 3 and 4 wound classes was higher (12.7%/11.9%vs10.4%/7.4%;p<0.01) as was the use of biologic mesh (30.0% vs 17.4%; p < 0.01). There were no significant differences in defect (208.3±165.4 cm2 vs 216.4 ±254.2cm2; p=0.16) or mesh size (824.1±477.7 cm2 vs 769.1±426.2cm2; p=0.99). ERAS patients had fewer panniculectomies (21.7%vs28.0%;p=0.02) and shorter operative time (176.3±81.6 vs 186.3±87.5min; p=0.01). Mean LOS shorter for ERAS patients (6.5±4.8vs7.2±7.1;p<0.01). When transversus abdominis plane block was added (2018), LOS decreased further (6.0±6.0 days) and narcotic use decreased by 65.1% (each:p<0.05). ERAS had fewer wound complications (14.1%vs32.3%;p<0.01), mesh infections (0.6 %vs2.5%; p<0.01), and 30-day readmissions (2.5%vs11.4%;p<0.01). In logistic regression, BMI, operation time, and panniculectomy increased risk for wound complications. Conclusions ERAS measures improve multiple aspects of AWR patient outcomes including LOS, wound complications and readmissions.