Table 1_Discharge-excluded enhanced recovery after surgery adherence and hospital length of stay after laparoscopic hysterectomy for benign disease: a secondary analysis.docx

Model-standardized LOS was estimated at five observed completion counts.</p>Results<p>Mean discharge-excluded adherence was 81.1% ± 5.6% (11.36 ± 0.79 of 14 items), and 144/145 patients were at or above the historical 70% threshold. In the primary ordinal model, documented chronic comorbidity was associated with lower odds of higher completion category (adjusted odds ratio 0.37, 95% CI 0.18–0.76; p = 0.007), but this estimate attenuated when carbohydrate loading was removed from the score (adjusted odds ratio 0.72, 95% CI 0.37–1.41; p = 0.337).

Mean LOS was 4.2 ± 1.9 days, and median LOS was 4 days (IQR 3–4). Each 10-percentage-point increase in discharge-excluded adherence was associated with lower expected LOS (adjusted incidence rate ratio 0.79, 95% CI 0.66–0.93; p = 0.005), equivalent to an adjusted incidence rate ratio of 0.84 per additional completed item (95% CI 0.75–0.95; p = 0.005). At the five observed completion counts of 9, 10, 11, 12, and 13 items, standardized expected LOS was 6.05, 5.12, 4.35, 3.71, and 3.20 days, respectively.

In the simultaneous phase-specific model, preoperative and intraoperative adherence were not independently associated with LOS, whereas postoperative adherence excluding discharge was inversely associated with LOS.</p>Conclusion<p>Higher discharge-excluded ERAS adherence was associated with shorter hospitalization, but the magnitude of the association was sensitive to influential observations, and the phase-specific signal was confined to postoperative adherence.

Because postoperative adherence and recovery overlap in time, causal inference is not warranted.</p>