Malignant disease,Prognosis and adjuvant therapy,Functional outcomes,Postoperative outcome & ERAS
- The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay
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James Wei Tatt Toh, Jack Cecire, Kerry Hitos, Karen Shedden, Fiona Gavegan, Nimalan Pathmanathan, Toufic El Khoury, Angelina Di Re, Annelise Cocco, Alex Limmer, Tom Liang, Kar Yin Fok, James Rogers, Edgardo Solis, Grahame Ctercteko
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Ann Coloproctol. 2022;38(1):36-46. Published online May 6, 2021
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DOI: https://doi.org/10.3393/ac.2020.11.23
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 Abstract
 PDF Supplementary Material
- Purpose
Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).
Methods
This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed.
Results
ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.
Conclusion
Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.
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Citations
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