Reduced LOS in colorectal surgery after ERP implementation

Patient Population
Open or laparoscopic colorectal surgery.

LiDCO Monitor*
LiDCOrapid as part of an enhanced recovery program (ERAS).

Trial Design
Before vs after ERAS introduction.

Outcome Impact
LOS reduced by 2 days (7 to 5), lower urinary infections (13% v 24%) & 30 day readmission rates 9.8% v 20.2%.

BACKGROUND
Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilisation and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major US teaching hospital.

METHODS
Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and peri-operative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates.

RESULTS
There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02).

DISCUSSION
Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in US hospitals.

*Deltex Medical ODM monitor also used as part of this study

Miller T, Thacker J, White W, Mantyh C, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 2014;118:1052–61.

Outcome showed LOS reduced by 2 days (7 to 5), lower urinary infections (13% v 24%) & 30-day readmission rates 9.8% v 20.2%.

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