Implementing ERAS: How We Achieved Success Within an Anesthesia Department

^aThe above table provides unadjusted comparison of compliance measures between the two periods under study: baseline vs intervention and intervention vs post-intervention. Compared to the baseline period, four of the five metrics showed significant improvement during the intervention period. Moreover, all these improvements were sustained during the post intervention period (there were some marginal changes, but none of them were statistically significant). Use of antiemetics, which had already 91.3% compliance during the baseline period, didn't show significant movement during the intervention or post-intervention period

*These results are based on regression models that controlled for the following covariates: age, heart rate, systolic blood pressure, BMI category (normal, overweight, obese, unknown), ASA category (healthy, mild, sever, missing), hysterectomy type (laparoscopic, vaginal, debulk-open, plain open), section (oncology, endocrinology, MIGS, pelvic medicine, specialist), ERAS Measures (in each ERAS model, we included the other remaining four. For example, when we assess use of short acting narcotics, we controlled for use of long acting narcotics, preemptive analgesia, antiemetics use and intraop fluid administration)
**The first three metrics are measured as binary (yes/no) outcomes and we used logistic regression to model them. The two last two are measured as a continuous outcome in microgram/kg and are modeled using generalized linear model with log link and gamma distribution
***Results show, except for use of antiemetics, which was already high during the baseline period, the other four ERAS measures have significantly improved in the intervention period (relative to baseline period) and these improvements were sustained during the post-intervention period

Authors and Disclosures

Dan B. Ellis¹*, Aalok Agarwala^2,3, Elena Cavallo⁴, Pam Linov⁴, Michael K. Hidrue⁴, Marcela G. del Carmen⁵ and Rachel Sisodia<sup>5

1</sup>Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. ²Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, USA. ³Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. ⁴Massachusetts General Physicians Organization, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA. ⁵Department of Gynecology Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.

*Correspondence
dbellis@mgh.harvard.edu

Authors' contributions
Dan Ellis is the primary author of the manuscript and may be reached at dbellis@mgh.harvard.edu. Aalok Agarwala contributed text to the manuscript. Elena Cavallo contributed text to the manuscript. Pam Linov contributed text to the manuscript. Michael Hidrue contributed text and performed statistical analysis. Marcela G. del Carmen contributed text to the manuscript. Rachel Sisodia contributed text to the manuscript. All authors approve the manuscript.

Competing interests
The authors declare that they have no competing interests.