1245 Enhanced Recovery Program in Colorectal Surgery at Basildon And Thurrock University Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Salim Chetitah ◽  
S Seraj ◽  
A Robinson ◽  
S Adetoye ◽  
Samer Haque
Keyword(s):  
Multidisciplinary Approach ◽  
Colorectal Resection ◽  
Enhanced Recovery ◽  
University Hospital ◽  
Perioperative Analgesia ◽  
Nice Guideline ◽  
Enhanced Recovery Program ◽  
Prolonged Hospital ◽  
Recovery Program ◽  
Care Costs

Abstract Introduction Enhanced recovery program (ERP) is an integrated multidisciplinary approach that requires participation and commitment from different member of staff, and the patient. This is an evidence-based protocol designed to standardize medical care, improve outcomes, and lower care costs. The aim of this study is to observe how ERP protocol is followed in our institution, and to monitor different outcomes. Data was compared to NICE guideline. Method We reviewed all patients who underwent elective colorectal resection for cancer between June 2018 and May 2019. data was collected retrospectively from patient electronic case notes. We monitored compliance with ERP protocol (NICE), as well as outcomes Results 114 patients were included in our study. We noted that just 35% of patients had intraoperative nasogastric tube. Antibiotics: 74.56%, Catheter 98.24%, PCA 79.82%, Spinal anaesthesia 52.63%, Drain 38.59%. In the post op period, patients were mobilized at 1.89 day (1.27) [mean (SD)], NGT removal: 1.81 day (2.31) Refeeding: 1.36 day (1.01). It has been proven that patients with inadequate perioperative analgesia are more prone to develop ileus, to have a prolonged hospital stay, and have an overall higher mortality (p0.001) Conclusions It seems that there is a room for improvement especially in analgesia and prophylactic antibiotics. Following ERP protocols improves overall outcomes.

Enhanced Recovery Program following Colorectal Resection in the Elderly Patient

2011 ◽  
Vol 36 (2) ◽  
pp. 415-423 ◽  
Author(s):  
Nikhil Pawa ◽  
Paul L. Cathcart ◽  
Tan H. A. Arulampalam ◽  
Matthew G. Tutton ◽  
Roger W. Motson
Keyword(s):  
Elderly Patient ◽  
Colorectal Resection ◽  
Enhanced Recovery ◽  
The Elderly ◽  
Enhanced Recovery Program ◽  
Recovery Program

scholarly journals Sustainability of an Enhanced Recovery Program for Pancreaticoduodenectomy with Pancreaticogastrostomy

2018 ◽  
Vol 108 (1) ◽  
pp. 17-22 ◽  
Author(s):  
C. Williamsson ◽  
T. Karlsson ◽  
M. Westrin ◽  
D. Ansari ◽  
R. Andersson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Positive Outcome ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Adherence Rate ◽  
Strict Adherence ◽  
Abdominal Drain ◽  
Enhanced Recovery Program ◽  
Recovery Program

Background: Enhanced recovery program for pancreaticoduodenectomy have become standard care. Little is known about adherence rates and sustainability of the program, especially when pancreaticogastrostomy is used in reconstruction. The aim of this study was, therefore, to evaluate adherence rates and continued outcome, after implementation of an enhanced recovery program. Methods: Consecutive patients undergoing pancreaticoduodenectomy at the Department of Surgery, Skåne University Hospital, Lund, Sweden were followed, after implementation of enhanced recovery program, October 2012. In April 2015, some items in the enhanced recovery program were modified, namely earlier removal of nasogastric tubes and abdominal drain. The patients were analyzed in three groups, the implementation group (control) and two post-implementation groups; intermediate and modified group. Sustainability was assessed according to length of stay and adherence rate. Results: In total, 160 patients were identified. The overall protocol adherence rate increased from 65% to 72%, p = 0.035. While the pre- and intraoperative protocol items were fulfilled to more than >90%, the postoperative were lower, but increasing over time; 48%, 50%, and 58%, p = 0.033. Postoperative complications and hospital length of stay did not change significantly. Conclusion: The positive outcome of an enhanced recovery program for pancreaticoduodenectomy was reasonably well sustained. Compliance with the protocol has increased, but strict adherence remains a challenge, especially with the postoperative items.

scholarly journals Patients’ refusal as major limitation of early discharge after colorectal resection in an enhanced recovery program

2020 ◽  
Vol 405 (3) ◽  
pp. 337-344 ◽  
Author(s):  
Maxime K. Collard ◽  
Morgan Anyla ◽  
Jérémie H. Lefevre ◽  
Conor Shields ◽  
Anaïs Laforest ◽  
...  
Keyword(s):  
Colorectal Resection ◽  
Enhanced Recovery ◽  
Early Discharge ◽  
Enhanced Recovery Program ◽  
Recovery Program

Successful Enhanced Recovery Program after Colorectal Surgery in a County Institution

2010 ◽  
Vol 76 (10) ◽  
pp. 1158-1162 ◽  
Author(s):  
Armen Aboulian ◽  
Zailani Hassan ◽  
Matthew Y.C. Lin ◽  
Amy H. Kaji ◽  
Ravin R. Kumar
Keyword(s):  
Colorectal Surgery ◽  
Hospital Stay ◽  
Colorectal Resection ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Intravenous Fluids ◽  
Strict Adherence ◽  
Enhanced Recovery Program ◽  
Significant Difference ◽  
Recovery Program

Enhanced recovery programs after colorectal surgery have gained acceptance recently as they have shown a decrease length of hospital stay. However, these pathways require strict adherence to standardized programs with patient education and high compliance. This study was designed to assess the feasibility of such a program in a large county hospital. A retrospective review was performed of 54 consecutive patients who underwent laparoscopic or open segmental colorectal resection without an ostomy. The first 27 patients were treated in a conventional manner, whereas the latter 27 were treated using a protocol promoting early feeding and ambulation with decreased intravenous fluids and narcotic use. There were no baseline differences between the groups, however, there was a significant difference in the patients treated with the enhanced recovery program in terms of less intravenous fluids administered in surgery ( P = 0.001), and over the subsequent 3 days ( P = 0.0017), with a decrease in length of hospital stay of 4 compared with 6 days ( P = 0.003). There were no differences in terms of complication and readmission rates. Based on this study, we conclude that strict adherence to a standard enhanced recovery program was effective in reducing hospital stay in patients undergoing colorectal resection without any increase in complications.

scholarly journals Impact of Enhanced Recovery Program (ERP) on Clinical Outcomes After Elective Colorectal Surgery in a Rural Hospital: A Prospective Cohort Study with Retrospective Control.

2021 ◽  
Author(s):  
ANTONIO PESCE ◽  
Mattia Portinari ◽  
Nicolò Fabbri ◽  
Valeria Sciascia ◽  
Lisa Uccellatori ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Functional Recovery ◽  
Enhanced Recovery ◽  
Mortality Rates ◽  
Rural Hospital ◽  
Elective Colorectal Surgery ◽  
Enhanced Recovery Program ◽  
Prolonged Hospital ◽  
Recovery Program

Abstract Introduction: The main purpose was to determine the impact on postoperative outcome of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital. Methods A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018–2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013–2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, inflammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as factors predicting both postoperative complications and prolonged hospital LoS. Results Baseline characteristics were comparable in both groups. Laparoscopic approach was performed in 95% of patients in the ERP group versus 0% in pre-ERP group. The median adherence to ERP protocol elements was 68% as opposed to 12% in the retrospective control group. The median hospital LoS in the ERP-group was significantly lower than in the pre-ERP group (5 vs. 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥ 30 and the traditional perioperative protocol were the independent predictive factors of postoperative complications, while following a traditional peri-operative protocol was the only factor predicting a prolonged hospital LoS. Conclusions Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort. For patients in such areas, colorectal ERP in elective surgery may also reduce time to functional recovery, postoperative hospital LoS and complications, with no increase in mortality and 30-day re-admissions.

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