Effect on short-term outcomes in elective colorectal surgery after optimising the enhanced recovery pathway. Our experience in a tertiary care university hospital

Introduction: Obese patients are considered at increased risk of postoperative adverse events after colorectal surgery. Objective: The objective of the present study was to compare postoperative outcomes between obese and non-obese patients undergoing elective colorectal surgery in an Enhanced Recovery After Surgery (ERAS) program. Methods: A retrospective analysis of a prospective cohort including patients who underwent elective colorectal surgery and were included in an ERAS protocol between February 2014 and December 2017 at Geneva University Hospital, Geneva, Switzerland, was performed. Postoperative outcomes of obese and non-obese patients were compared. Results: Data of 460 patients were analyzed, including 374 (81%) non-obese and 86 (19%) obese patients. Overall, there was no difference in postoperative outcomes between the 2 groups. Among patients undergoing oncologic surgery, obese subjects had a significantly higher rate of conversion to laparotomy (11.9 vs. 2.1%, p = 0.01) and longer time until return of bowel function (2.38 vs. 1.98 days, p = 0.03), without increased morbidity or longer length of stay. Conclusion: Obese and non-obese patients had similar postoperative outcomes after elective colorectal surgery with ERAS management. ERAS can potentially reduce the increased morbidity usually observed in obese patients following elective colorectal surgery.

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American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery

Perioperative Medicine ◽

10.1186/s13741-017-0059-2 ◽

2017 ◽

Vol 6 (1) ◽

Cited By ~ 32

Author(s):

Stefan D. Holubar ◽

◽

Traci Hedrick ◽

Ruchir Gupta ◽

John Kellum ◽

...

Keyword(s):

Colorectal Surgery ◽

Postoperative Infection ◽

Consensus Statement ◽

Enhanced Recovery ◽

Elective Colorectal Surgery ◽

Enhanced Recovery Pathway ◽

American Society

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Clinical outcomes of the very elderly undergoing enhanced recovery programmes in elective colorectal surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.0036 ◽

2016 ◽

Vol 98 (1) ◽

pp. 29-33 ◽

Cited By ~ 5

Author(s):

MA Khan ◽

S Pandey

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Large Scale ◽

Enhanced Recovery ◽

Elective Surgery ◽

Complication Rates ◽

Very Elderly ◽

Short Term ◽

Elective Colorectal Surgery

Introduction Enhanced recovery programmes (ERPs) have been shown to improve short-term outcomes after major colorectal surgery. Benefits of the ERP in patients who are very elderly (VE) are less well understood. We aimed to evaluate the role of the ERP in the VE population, which for the purpose of this study was defined as any patient aged 75 years or over. Methods A prospectively compiled database was used to identify all patients aged ≥75 years who underwent elective colorectal resection in our unit between January 2011 and September 2012. These data were analysed to study the short-term outcomes in these patients and compared with those of patients aged <75 years. Results Overall, 352 patients underwent elective surgery during this period; 106 were identified as VE. The median length of stay (LOS) in the VE group was 7 days (5 days in non-VE group; p=0.002). Two-thirds (62%) underwent laparoscopic surgery. The median LOS of VE patients undergoing laparoscopic surgery was 6 days (11 days for open surgery; p=0.003). A third (33%) of the VE cohort was discharged by day 5. Of these patients, 85% underwent laparoscopic surgery. There was no statistical difference in overall complication rates (VE vs non-VE). Conclusions Accepting that some VE patients may stay in hospital for longer, this study supports our current policy of including everyone in the ERP regardless of age. Patients undergoing laparoscopic surgery appear to benefit, with a shorter LOS. Further large scale trials are required to support the results of this study and to identify long-term outcomes.

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