Instituting an ERAS protocol for colorectal surgery in a large teaching community hospital decreases length of stay and cost while improving functional status on discharge

2017 ◽  
Vol 19 ◽  
pp. 91
Author(s):  
Luciana Mullman ◽  
Ope Popoola ◽  
Mark Gilder ◽  
Richard Pitera ◽  
Varun Chakravorty
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Functional Status ◽  
Community Hospital ◽  
Teaching Community ◽  
Eras Protocol

scholarly journals Implementation of an ERAS Pathway in Colorectal Surgery

2019 ◽  
Vol 32 (02) ◽  
pp. 102-108 ◽  
Author(s):  
Liliana Bordeianou ◽  
Paul Cavallaro
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Standardized Protocol ◽  
Improve Hospital ◽  
Eras Protocol

AbstractEnhanced Recovery after Surgery (ERAS) protocols have been demonstrated to improve hospital length of stay and outcomes in patients undergoing colorectal surgery. This article presents the specific components of an ERAS protocol implemented at the authors' institution. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Evidence supporting inclusion of various aspects within the ERAS protocol is briefly reviewed. The ERAS protocol described has significantly benefitted postoperative outcomes in colorectal patients and can be employed at other institutions wishing to develop an ERAS pathway for colorectal patients. A checklist is provided for clinicians to easily reference and facilitate implementation of a standardized protocol.

Implementation of ERAS protocol in elective colorectal surgery results in reduction in length of stay; discharge within 48 hours is feasible and safe

2019 ◽  
Vol 45 (2) ◽  
pp. e50
Author(s):  
B. Van Den Hengel ◽  
H. Smid-Nanninga ◽  
A.F.T. Olieman ◽  
L.S. Wagenaar ◽  
W. Kelder ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Elective Colorectal Surgery ◽  
Eras Protocol

23-Hour Stay Outcomes for Laparoscopic Roux-en-Y Gastric Bypass in a Small, Teaching Community Hospital

2008 ◽  
Vol 74 (12) ◽  
pp. 1206-1210 ◽  
Author(s):  
Louis G. Fares ◽  
Rachel C. Reeder ◽  
John Bock ◽  
Valerie Batezel
Keyword(s):  
Gastric Bypass ◽  
Length Of Stay ◽  
Obesity Surgery ◽  
Risk Score ◽  
Mortality Risk ◽  
Community Hospital ◽  
Successful Outcome ◽  
Morbidly Obese ◽  
Teaching Community ◽  
Surgery Mortality

The goal of every surgery is a successful outcome with the shortest hospital stay. Morbidly obese patients with their myriad of comorbidities have confounded surgeons over the years, usually leading to an increased length of hospital stays after complicated surgeries. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proven to be an effective treatment for the morbidly obese with a usual length of stay of 3 days. The purpose of this article is to review our experience with 23-hour stays for LRYGB over a 13-month period and to apply a recently published risk score to these patients. A single surgeon performed 173 bariatric surgeries of which 96 were LRYGB, the study group. The demographics of this group found the overwhelming majority were female, white, slightly older than the men but with a somewhat smaller body mass index (BMI). The ethnic breakdown was 67.7 per cent white, 22.9 per cent black, and 9.4 per cent Hispanic. The average for all patients was 41.7 years and the BMI was 49.25 kg/m2. Using the Obesity Surgery Mortality Risk Score, 62.5 per cent of our patients were low risk or Class A, 37.5 per cent intermediate risk or Class B, and none of our patients qualified as high risk or Class C. Our average patient score was 1.3. In terms of length of stay, 91 of the 96 patients (94.8%) were discharged within 23 hours of surgery without mortality or 30-day readmission. The remaining five patients (5.2%) had unexplained, sustained tachycardia and were re-explored on the first postoperative day laparoscopically. Three of these patients had negative explorations. One had a jejunojejunostomy revision and the other was found to have a small bowel injury, which was laparoscopically repaired. All five patients were discharged within the next 23 hours. All patients were discharged on a clear liquid diet and advanced to a regular diet over the next month. No diet intolerance was noted nor were any patients converted to an open operation. In conclusion, we have demonstrated that a comprehensive bariatric program in a small teaching community hospital can successfully perform LRYGB and discharge a high percentage of patients within 23 hours with a very low complication rate. We also believe the Obesity Surgery Mortality Risk Score will help bariatric programs to risk-stratify their patients preoperatively. This will contribute to decision-making and further inform patients of their risk as part of their education preoperatively.

Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit

2001 ◽  
Vol 22 (02) ◽  
pp. 83-87 ◽  
Author(s):  
Joseph M. Mylotte ◽  
Robin Graham ◽  
Lucinda Kahler ◽  
B. Lauren Young ◽  
Susan Goodnough
Keyword(s):  
Length Of Stay ◽  
Nosocomial Infection ◽  
Functional Status ◽  
Functional Independence ◽  
Functional Improvement ◽  
Multivariate Linear Regression Analysis ◽  
Rehabilitation Unit ◽  
Cord Injury ◽  
Acute Rehabilitation ◽  
First Time

AbstractObjective:To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.Setting:A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.Study Population:All patients admitted to the unit between January 1997 and July 1998.Design:Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).Results:There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), andClostridium difficilediarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of ΔFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007).Conclusions:Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

scholarly journals Risk factors for prolonged length of stay after colorectal surgery

2013 ◽  
Vol 33 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Luiz Felipe de Campos Lobato ◽  
Patrícia Cristina Alves Ferreira ◽  
Elizabeth C. Wick ◽  
Ravi P. Kiran ◽  
Feza H. Remzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Prolonged Length

scholarly journals 129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Brennan
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Intravenous Fluid ◽  
Junior Doctors ◽  
Intravenous Fluids ◽  
Elective Colorectal Surgery ◽  
Royal Hospital ◽  
Elective Surgical Procedures ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

scholarly journals Robotic Radical Prostatectomy at a Teaching Community Hospital: Outcomes and Safety

2011 ◽  
Vol 15 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Julianna Padavano ◽  
Lynn Shaffer ◽  
Elizabeth Fannin ◽  
John Burgers ◽  
Wayne Poll ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Community Hospital ◽  
Hospital Outcomes ◽  
Robotic Radical Prostatectomy ◽  
Teaching Community

Impact of race on nonroutine discharge, length of stay, and postoperative complications after surgery for spinal metastases

2021 ◽  
pp. 1-8
Author(s):  
Bethany Hung ◽  
Zach Pennington ◽  
Andrew M. Hersh ◽  
Andrew Schilling ◽  
Jeff Ehresman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Marital Status ◽  
Functional Status ◽  
Independent Predictor ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Comprehensive Cancer Center ◽  
Insurance Status ◽  
Income Quartile

OBJECTIVE Previous studies have suggested the possibility of racial disparities in surgical outcomes for patients undergoing spine surgery, although this has not been thoroughly investigated in those with spinal metastases. Given the increasing prevalence of spinal metastases requiring intervention, knowledge about potential discrepancies in outcomes would benefit overall patient care. The objective in the present study was to investigate whether race was an independent predictor of postoperative complications, nonroutine discharge, and prolonged length of stay (LOS) after surgery for spinal metastasis. METHODS The authors retrospectively examined patients at a single comprehensive cancer center who had undergone surgery for spinal metastasis between April 2013 and April 2020. Demographic information, primary pathology, preoperative clinical characteristics, and operative outcomes were collected. Factors achieving p values < 0.15 on univariate regression were entered into a stepwise multivariable logistic regression to generate predictive models. Nonroutine discharge was defined as a nonhome discharge destination and prolonged LOS was defined as LOS greater than the 75th percentile for the entire cohort. RESULTS Three hundred twenty-eight patients who had undergone 348 operations were included: 240 (69.0%) White and 108 (31.0%) Black. On univariable analysis, cohorts significantly differed in age (p = 0.02), marital status (p < 0.001), insurance status (p = 0.03), income quartile (p = 0.02), primary tumor type (p = 0.04), and preoperative Karnofsky Performance Scale (KPS) score (p < 0.001). On multivariable analysis, race was an independent predictor for nonroutine discharge: Black patients had significantly higher odds of nonroutine discharge than White patients (adjusted odds ratio [AOR] 2.24, 95% confidence interval [CI] 1.28–3.92, p = 0.005). Older age (AOR 1.06 per year, 95% CI 1.03–1.09, p < 0.001), preoperative KPS score ≤ 70 (AOR 3.30, 95% CI 1.93–5.65, p < 0.001), preoperative Frankel grade A–C (AOR 3.48, 95% CI 1.17–10.3, p = 0.02), insurance status (p = 0.005), being unmarried (AOR 0.58, 95% CI 0.35–0.97, p = 0.04), number of levels (AOR 1.17 per level, 95% CI 1.05–1.31, p = 0.004), and thoracic involvement (AOR 1.71, 95% CI 1.02–2.88, p = 0.04) were also predictive of nonroutine discharge. However, race was not independently predictive of postoperative complications or prolonged LOS. Higher Charlson Comorbidity Index (AOR 1.22 per point, 95% CI 1.04–1.43, p = 0.01), low preoperative KPS score (AOR 1.84, 95% CI 1.16–2.92, p = 0.01), and number of levels (AOR 1.15 per level, 95% CI 1.05–1.27, p = 0.004) were predictive of complications, while insurance status (p = 0.05), income quartile (p = 0.01), low preoperative KPS score (AOR 1.64, 95% CI 1.03–2.72, p = 0.05), and number of levels (AOR 1.16 per level, 95% CI 1.05–1.30, p = 0.004) were predictive of prolonged LOS. CONCLUSIONS Race, insurance status, age, baseline functional status, and marital status were all independently associated with nonroutine discharge. This suggests that a combination of socioeconomic factors and functional status, rather than medical comorbidities, may best predict postdischarge disposition in patients treated for spinal metastases. Further investigation in a prospective cohort is merited.

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