Introducing an enhanced recovery after surgery (ERAS) pathway for regional lymph node dissection: clinical and financial implications

Enhanced recovery after surgery (ERAS) protocols aim to improve patient care, reduce complication rates and shorten hospital stay following surgery. The key elements of these protocols include preoperative counselling, standardized analgesia and early mobilization. We present our experience in applying ERAS pathway for skin cancer patients requiring regional lymph node dissection (LND). Our protocol streamlines from the initial clinic consultation and perioperative management to safe discharge and regular clinic follow-up. Prospective data collection of 100 consecutive patients who underwent LND, performed by the senior author, was done. Data included patient demographics, initial diagnosis, initial clinic appointment, surgery date, discharge date, number of follow-up clinics and complications. Our results were compared to the results of an audit of 50 consecutive patients managed in our department prior to the introduction of the presented protocol. Our ERAS pathway resulted in a shorter hospital stay and fewer complication rates. Our patients were discharged, with drains in situ. Our mean length of stay (LOS) for axillary, inguinal and neck LND was 1.18, 2 and 4.1 days, respectively. The overall LOS was 2.4 versus 9.5 days in the audited previous practice. Our complication rate was 50 % less (P = 0.002). This also resulted in substantial financial savings. ERAS protocol for skin cancer patients requiring LND is based on multi-disciplinary team (MDT) approach. It has proven to be an efficient and safe streamlined pathway from consultation to discharge, with shorter hospital stay and satisfactory clinical outcomes as well as substantial financial savings that could be recruited in other services. Level of Evidence: Level III, risk/prognostic study.