RT Journal Article SR Electronic T1 Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components JF BMJ Surgery, Interventions, & Health Technologies FD BMJ Publishing Group Ltd SP e000087 DO 10.1136/bmjsit-2021-000087 VO 3 IS 1 A1 Rachel C. Sisodia A1 Dan Ellis A1 Michael Hidrue A1 Pamela Linov A1 Elena Cavallo A1 Allison S. Bryant A1 May Wakamatsu A1 Marcela G. del Carmen YR 2021 UL http://sit.bmj.com/content/3/1/e000087.abstract AB Objective The goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.Design A cohort study.Setting Large tertiary academic medical centre.Participants The study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).Intervention The addition of ERAS to perioperative care.This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.Main outcome measures Impact of ERAS process measure adherence on length of stay.Results After initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (−30%, 95% CI −18% to 40%) and decreased postoperative fluid administration (−12%, 95% CI −1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (−53%, 95% CI −55% to 52%).Conclusions While adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.Data are available on reasonable request. Dissemination to participants and related patient and public communities: We do not plan any participant dissemination as there were no public member or patient participant involvement. We will widely disseminate the results of this study to professional colleagues and to the public, through conference and meeting presentations and media reporting.