Commentary on: ‘Predictors of length of stay in patients having elective colorectal surgery within an enhanced recovery protocol’ Int J Surg 2010; 8: 628-32.

Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016. The protocol was employed in colorectal cases, both elective and emergent. Data from ERP cases were compared with contemporaneous controls that did not go through the ERP. Patients who underwent colorectal procedures and participated in the ERP with the expanded preoperative component had an average LOS of 5.33 days, whereas controls stayed for an average of 7.93 days (P value, <0.01). ERP cases also experienced fewer read-missions and complications, although statistical significance could not be established. The results demonstrate that an ERP with an enhanced preoperative component significantly reduces LOS and potentially decreases the rate of readmissions and total complications.

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Enhanced Recovery Protocol: Implementation at a County Institution with Limited Resources

The American Surgeon ◽

10.1177/000313481207801006 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1041-1044

Author(s):

Kais Rona ◽

J. Choi ◽

G. Sigle ◽

S. Kidd ◽

G. Ault ◽

...

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Compliance Rate ◽

Implementation Process ◽

Care Plan ◽

Elective Colorectal Surgery ◽

Resource Limited ◽

Standard Order ◽

Common Process ◽

Enhanced Recovery Protocol

The benefits of an enhanced recovery protocol (ERP) in colorectal surgery have been well described; however, data on the implementation process is minimal, especially in a resource-limited institution. The purpose of this study was to evaluate outcomes during implementation of a physician-driven ERP at a public-funded institution. We retrospectively reviewed all elective colorectal surgery during a transition from standard care to an ERP (implemented via a standard order sheet). Data regarding use of care plan, length of stay (LOS), and rates of postoperative complications and readmission were recorded. One hundred eleven patients were included in the study; however, complete use of the ERP after its introduction occurred in a total of 50 patients for a compliance rate of 60 per cent (95% confidence interval [CI], 49 to 70). Late implementation of ERP diet, analgesics, and activity were the most common process errors. Full application of the ERP reduced mean LOS by 3 days ( P = 0.002), and there was a trend toward decreased postoperative morbidity without an increase in readmission rate ( P = 0.61). Full implementation of an ERP for colorectal surgery faces many challenges in a resource-limited county institution; however, when fully applied, the ERP safely reduced overall LOS, which is important in cost containment.

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Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.12.042 ◽

2015 ◽

Vol 220 (4) ◽

pp. 430-443 ◽

Cited By ~ 192

Author(s):

Robert H. Thiele ◽

Kathleen M. Rea ◽

Florence E. Turrentine ◽

Charles M. Friel ◽

Taryn E. Hassinger ◽

...

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Enhanced Recovery ◽

Direct Costs ◽

Enhanced Recovery Protocol

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Laparoscopic approach and patient length of stay in elective colorectal surgery without an enhanced recovery programme

ANZ Journal of Surgery ◽

10.1111/ans.12547 ◽

2014 ◽

Vol 84 (7-8) ◽

pp. 502-503 ◽

Cited By ~ 3

Author(s):

Irshad Shaikh ◽

Mohammed Boshnaq ◽

Nusrat Iqbal ◽

Sudhakar Mangam ◽

George Tsavellas

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Enhanced Recovery ◽

Laparoscopic Approach ◽

Elective Colorectal Surgery ◽

Enhanced Recovery Programme

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Effect of implementing an enhanced recovery protocol for pediatric colorectal surgery on complication rate, length of stay, and opioid use in children

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2022.01.004 ◽

2022 ◽

Author(s):

Jessica A. George ◽

Andres J. Gonzalez Salazar ◽

Ahmer Irfan ◽

Laura Prichett ◽

Isam W. Nasr ◽

...

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Complication Rate ◽

Enhanced Recovery ◽

Opioid Use ◽

Enhanced Recovery Protocol

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ERAS® Program in a Portuguese Hospital: Results from Elective Colorectal Surgery after One Year of Implementation

Acta Médica Portuguesa ◽

10.20344/amp.11158 ◽

2020 ◽

Vol 33 (9) ◽

pp. 568

Author(s):

André Carrão ◽

Daniel Ribeiro ◽

Maria Manso ◽

Joana Oliveira ◽

Luís Féria ◽

...

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Propensity Score ◽

Propensity Score Matching ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Bowel Function ◽

Control Group ◽

Elective Colorectal Surgery ◽

Improve Patient

Introduction: The Enhanced Recovery After Surgery® program comprises the implementation of various perioperative measures that reduce surgical stress and ultimately improve patient recovery and outcome. The purpose of this study is to evaluate the first-year compliance and clinical outcomes after implementation of the Enhanced Recovery After Surgery® program in elective colorectal surgery in our hospital.Material and Methods: An analysis was performed on the 210 patients who underwent elective colorectal surgery from May 2016 to December 2017. The group of patients that underwent surgery after the protocol implementation (Enhanced Recovery After Surgery® group) was compared to a conventional care control group (pre- Enhanced Recovery After Surgery® group). Differences between the two groups were adjusted using Propensity Score matching. The main outcomes were length of stay, return of bowel function, complications and mortality. The evolution of compliance with Enhanced Recovery After Surgery® principles was also analyzed.Results: After propensity score matching, 112 patients were included in the present study: 56 patients formed the pre-Enhanced Recovery After Surgery® group and 56 the Enhanced Recovery After Surgery® group. The overall adherence to the protocol increased from 35.7% to 80.8%. There was a decrease in length of stay, time to return of bowel function and medical complications.Discussion: The Enhanced Recovery After Surgery® program is safe and seems to shorten length of stay and improve patient recovery and clinical outcome.Conclusion: This study showed that the implementation of the Enhanced Recovery After Surgery® program was possible in Hospital Beatriz Ângelo, with a positive impact in the immediate postoperative recovery of colorectal patients.

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Effectiveness and safety of the enhanced recovery program in colorectal surgery: overview of systematic reviews

Colombian Journal of Anesthesiology ◽

10.5554/22562087.e943 ◽

2020 ◽

Author(s):

Kelly Rocío Chacón Acevedo ◽

Édgar Cortés Reyes ◽

Óscar Alexander Guevara Cruz ◽

Jorge Augusto Díaz Rojas ◽

Lina María Rincón Martínez

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Systematic Reviews ◽

Perioperative Care ◽

Enhanced Recovery ◽

Hospital Length ◽

The Body ◽

Hospital Length Of Stay ◽

Secondary Outcome ◽

Elective Colorectal Surgery

Introduction: Multimodal enhanced recovery programs are a new paradigm in perioperative care. Objective: To evaluate the certainty of evidence pertaining to the effectiveness and safety of the multimodal perioperative care program in elective colorectal surgery. Data source: A search was conducted in the Medline, EMBASE, and Cochrane databases, up until February 2020. Eligibility criteria: Systematic reviews that take into account the perioperative multimodal program in patients with an indication for colorectal surgery were included. The primary outcomes were morbidity and postoperative deaths. The secondary outcome was hospital length of stay. Study quality and synthesis method: The reviews were evaluated with AMSTAR-2 and the certainty of the evidence with the GRADE methodology. The findings are presented with measures of frequency, risk estimators, or differences. Results: Six systematic reviews of clinical trials with medium and high quality in AMSTAR-2 were included. Morbidity was reduced between 16 and 48%. Studies are inconclusive regarding postoperative mortality. Hospital length of stay was reduced by an average of 2.5 days (p <0.05). The certainty of the body of evidence is very low. Limitations: The effect of the program, depending on the combination of elements, is not clear. Conclusions and implications: Despite the proven evidence that the program is effective in reducing global postoperative morbidity and hospital stay, the body of evidence is of very low quality. Consequently, results may change with new evidence and further research is required.

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Impact of Multimodality Pain Regimens on Elective Colorectal Surgery Outcomes

The American Surgeon ◽

10.1177/000313481708300432 ◽

2017 ◽

Vol 83 (4) ◽

pp. 414-420

Author(s):

Jennifer A. Kaplan ◽

Emily Finlayson ◽

Andrew D. Auerbach

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Confidence Interval ◽

Readmission Rate ◽

Enhanced Recovery ◽

Elective Colorectal Surgery ◽

Lengths Of Stay ◽

Propensity Matching ◽

Secondary Analyses ◽

Enhanced Recovery Programs

Trials of enhanced recovery programs suggest that multimodality pain regimens improve outcomes after colorectal surgery. We sought to determine whether patients receiving postoperative multimodality pain regimens would have shorter lengths of stay without an associated increase in readmission rate as compared to those receiving opioid-based pain regimens. Retrospective cohort study of adults who underwent elective colorectal surgery between January 1, 2006, and December 31, 2012, in a national hospital network participating in the Premier Perspective database. Patients were grouped into multimodality or opioid-based using postoperative medication charges. Primary outcome measures included length of stay and 30-day readmission rate. Among 91,936 patients, 38 per cent received multimodality pain regimens and 61 per cent received opioid-based regimens. After adjustment for patient and surgical characteristics, there was no difference in length of stay or cost, odds of readmission were 1.2 (95% confidence interval = 1.2–1.3, P < 0.001), and odds of mortality were 0.8 (95% confidence interval = 0.6–0.9, P < 0.001) in the multimodality group compared to nonopioid sparing. Our results were consistent in secondary analyses using propensity matching. Fewer than half of patients undergoing elective colorectal surgery in our cohort received multimodality pain regimens, and receipt of these medications was associated with mixed benefits in terms of length of stay, readmission, and mortality.

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