Ann Coloproctol.
2022 Feb;38(1):36-46. 10.3393/ac.2020.11.23.
The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay
- Toh JWT
1,2,3 - Cecire J1
- Hitos K1,2,4
- Shedden K2
- Gavegan F2
- Pathmanathan N1,2
- El Khoury T1,2,5
- Di Re A2
- Cocco A2
- Limmer A2
- Liang T2
- Fok KY2
- Rogers J2
- Solis E2
- Ctercteko G1,2
- Affiliations
-
- 1Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- 2Department of Surgery, Westmead Hospital, Westmead, NSW, Australia
- 3Discipline of Surgery, University of New South Wales, Sydney, NSW, Australia
- 4Westmead Research Centre for Evaluation of Surgical Outcomes, Westmead Hospital, Sydney, NSW, Australia
- 5Discipline of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
- KMID: 2526565
- DOI: http://doi.org/10.3393/ac.2020.11.23
Abstract
- Purpose
Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).
Methods
This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed.
Results
ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.
Conclusion
Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.
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