Reducing the length of stay for patients undergoing colorectal surgery

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.

Download Full-text

Associations of a Preoperative Anemia and Suboptimal Iron Stores Screening and Management Clinic in Colorectal Surgery With Hospital Cost, Reimbursement, and Length of Stay

Anesthesia & Analgesia ◽

10.1213/ane.0000000000005241 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kevin M. Trentino ◽

Hamish Mace ◽

Kylie Symons ◽

Frank M. Sanfilippo ◽

Michael F. Leahy ◽

...

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Hospital Cost ◽

Preoperative Anemia ◽

Iron Stores

Download Full-text

Implementation of an ERAS Pathway in Colorectal Surgery

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1676474 ◽

2019 ◽

Vol 32 (02) ◽

pp. 102-108 ◽

Cited By ~ 9

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.

Download Full-text

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

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2017.04.058 ◽

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

Download Full-text

Variability in Length of Stay After Colorectal Surgery

Annals of Surgery ◽

10.1097/sla.0b013e3181fdf6c8 ◽

2010 ◽

Vol 252 (5) ◽

pp. 891-892 ◽

Cited By ~ 1

Author(s):

Ravikrishna Mamidanna ◽

Alex M. Almoudaris ◽

Omar Faiz

Keyword(s):

Colorectal Surgery ◽

Length Of Stay

Download Full-text

Surgical sepsis and delays in social services and intervention services account for prolonged hospital length of stay in general and colorectal surgery

International Journal of Surgery ◽

10.1016/j.ijsu.2013.06.181 ◽

2013 ◽

Vol 11 (8) ◽

pp. 620-621

Author(s):

Carl Kotze

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Social Services ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Intervention Services ◽

Prolonged Hospital

Download Full-text

Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.0018 ◽

2015 ◽

Vol 97 (7) ◽

pp. 530-533 ◽

Cited By ~ 13

Author(s):

ECG Tudor ◽

W Yang ◽

R Brown ◽

PM Mackey

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Malignant Disease ◽

Colorectal Resection ◽

Rectus Sheath ◽

Pain Scores ◽

Average Pain ◽

Open Colorectal Resection ◽

The Mean ◽

Mean Time

Introduction Rectus sheath catheters (RSCs) are increasingly being used to provide postoperative analgesia following laparotomy for colorectal surgery. Little is known about their efficacy in comparison with epidural infusion analgesia (EIA). They are potentially better as they avoid the recognised complications associated with EIA. This study compares these two methods of analgesia. Outcomes include average pain scores, time to mobilisation and length of stay. Methods This was a 33-month single centre observational study including all patients undergoing elective open or laparoscopic-converted-to-open colorectal resection for both benign and malignant disease. Patients received either EIA or RSCs. Data were collected prospectively and analysed retrospectively. Results A total of 95 patients were identified. Indications for surgery, operation and complications were recorded. The mean time to mobilisation was significantly shorter in patients who had RSCs compared with EIA patients (2.4 vs 3.5 days, p<0.05). There was no difference in postoperative pain scores or length of stay. Conclusions RSCs provide equivalent analgesia to EIA and avoid the recognised potential complications of EIA. They are associated with a shorter time to mobilisation. Their use should be adopted more widely.

Download Full-text