Impact of an Enhanced Recovery after Surgery Protocol on Unplanned Patient Encounters in the Early Post-Operative Period after Ureteroscopy.

INTRODUCTION Ureteroscopy is associated with substantial patient-perceived morbidity. To improve the patient experience, we developed an Enhanced Recovery After Surgery (ERAS) protocol for URS. We sought to determine whether an ERAS protocol would reduce unplanned patient-initiated encounters. METHODS The ERAS protocol involves the preoperative administration of four medications to patients undergoing URS. We reviewed data on 100 consecutive patients undergoing URS between April 2018 and August 2018. All unplanned post-operative encounters, including phone calls and online electronic medical record (EMR) messages, emergency department (ED) visits, and re-admissions within 30 days of surgery were recorded. A control group of patients undergoing URS between July 2013 and November 2014, served as a comparison group. Propensity score matching was performed. Statistical analysis included Mann-Whitney test, student's t-test and Fischer's exact. Univariable and multivariable analyses were performed. RESULTS Using propensity score matching, 71 pre-ERAS (median age 57 years IQR 44-65) and 71 post-ERAS (median age 56 years IQR 47-68) patients were compared. ED visits and post-operative readmissions were comparable between the two groups. Among 98 calls from 39 patients, more unplanned phone calls/messages occurred in the pre-ERAS group than in the post-ERAS group (71 versus 27, respectively, p < 0.001). Multivariable regression analysis identified the ERAS protocol as a significant independent predictor of fewer patient calls (OR 0.24, 95% CI 0.12 - 0.50, p < 0.001). CONCLUSIONS Early analysis of an ERAS protocol for patients undergoing URS showed a reduction in patient-initiated communication, with implementation of the protocol.