Adherence to Enhanced Recovery After Surgery and length of stay after colonic resection
Open Access
- 7 March 2013
- journal article
- research article
- Published by Wiley in Colorectal Disease
- Vol. 15 (8), 1019-1025
- https://doi.org/10.1111/codi.12200
Abstract
Aim The Enhanced Recovery After Surgery (ERAS) programme is a multimodal approach to improve peri‐operative care in colon surgery. The aim of this study was to report on the adherence to and outcomes of ERAS in the first years after implementation. Method Data of patients undergoing elective colon resections for malignancy in 2006 until 2010 were compared with patients receiving conventional care in 2005. Retrospective analysis was performed including length of stay (LOS), protocol adherence and complications. The predictive values of ERAS items and baseline characteristics on LOS and complications were analysed using univariate and multivariate analysis. Results Length of stay (LOS) was significantly shorter in 2006 and 2007 (P ≤ 0.009 and P ≤ 0.004) but not in 2008 and 2009. The mean adherence rate to the ERAS items was 84.1% in 2006 and 2007 and 72.4% in 2008 and 2009 (P < 0.001). In 2005, 2008 and 2009 LOS was significantly shorter for laparoscopically operated patients than for patients with open resections (P < 0.002, P < 0.001 and P < 0.004 respectively). Multivariate analysis showed that age, laparoscopic surgery, removal of nasogastric tube before extubation, mobilization within 24 h after surgery, starting nonsteroidal anti‐inflammatory drugs at day 1 and removal of thoracic epidural analgesia at day 2 were independent predictors of LOS. Conclusion Strict adherence to the ERAS protocol was associated with reduced LOS and improved outcome in elective colon surgery for malignancy. These benefits were lost when protocol adherence was lower. Embedding the ERAS protocol into an organization and repetitive education are vital to sustain its beneficial effects on LOS and outcome.Keywords
This publication has 21 references indexed in Scilit:
- Laparoscopy in Combination with Fast Track Multimodal Management is the Best Perioperative Strategy in Patients Undergoing Colonic SurgeryAnnals of Surgery, 2011
- The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trialsClinical Nutrition, 2010
- Determinants of outcome after colorectal resection within an enhanced recovery programmeBritish Journal of Surgery, 2009
- Strategies to help nurses cope with change in the healthcare settingNursing Standard, 2008
- Fast-track colorectal surgeryThe Lancet, 2008
- Length of Stay: An Inappropriate Readout of the Success of Enhanced Recovery ProgramsWorld Journal of Surgery, 2008
- A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgeryClinical Nutrition, 2005
- Colonic Surgery With Accelerated Rehabilitation or Conventional CareDiseases of the Colon & Rectum, 2004
- Prospective, Randomized, Controlled Trial Between a Pathway of Controlled Rehabilitation With Early Ambulation and Diet and Traditional Postoperative Care After Laparotomy and Intestinal ResectionDiseases of the Colon & Rectum, 2003
- Preoperative oral carbohydrates and postoperative insulinresistanceClinical Nutrition, 1999