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    Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

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    Date
    2014-05
    Authors
    Anstrom, Kevin J
    Edwards, R
    Eisenstein, EL
    Enhanced Recovery Study Group
    Gan, Tong Joo
    Jin, Juying
    Mantyh, Christopher Ritchie
    Migaly, J
    Miller, Timothy Ellis
    Moon, Richard Edward
    Roche, Anthony Michael
    Thacker, Julie K Marosky
    White, WD
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    Abstract
    BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.
    Type
    Journal article
    Subject
    Adult
    Aged
    Analgesia, Epidural
    Blood Substitutes
    Clinical Protocols
    Colorectal Surgery
    Cost Savings
    Costs and Cost Analysis
    Digestive System Surgical Procedures
    Female
    Humans
    Laparoscopy
    Length of Stay
    Linear Models
    Male
    Middle Aged
    Pain Measurement
    Pain, Postoperative
    Perioperative Care
    Sample Size
    Survival
    Treatment Outcome
    United States
    Permalink
    http://hdl.handle.net/10161/8598
    Published Version (Please cite this version)
    10.1213/ANE.0000000000000206
    Publication Info
    Anstrom, Kevin J; Edwards, R; Eisenstein, EL; Enhanced Recovery Study Group; Gan, Tong Joo; Jin, Juying; ... White, WD (2014). Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg, 118(5). pp. 1052-1061. 10.1213/ANE.0000000000000206. Retrieved from http://hdl.handle.net/10161/8598.
    This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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    Scholars@Duke

    Anstrom

    Kevin J. Anstrom

    Professor of Biostatistics and Bioinformatics
    My research interests include clinical trials, cost-benefit analysis, health economics, semiparametric estimation, and medical informatics.

    Tong Joo Gan

    Consulting Professor in the Department of Anesthesiology
    My current research interests include postoperative nausea and vomiting (PONV), acute postoperative pain, clinical pharmacology of anesthetic drugs and resuscitation fluids as well as database research in postoperative outcomes. Improving Outcome in Surgical Patients: Nausea and vomiting is regarded as one of the most unpleasant experiences in postoperative recovery. To date, there is no single antiemetic which can satisfactorily control PONV. My interests concentrate o
    Mantyh

    Christopher Ritchie Mantyh

    Professor of Surgery
    Neurogenic inflammation Ulcerative colitis Crohn's disease Neuropeptides Receptors Vanilloid receptor Substance P Intestinal motility Colorectal cancer outcomes Colon cancer Rectal cancer
    Migaly

    John Migaly

    Associate Professor of Surgery
    Miller

    Timothy Ellis Miller

    Associate Professor of Anesthesiology
    Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.
    Moon

    Richard Edward Moon

    Professor of Anesthesiology
    Research interests include the study of cardiorespiratory function in humans exposed to environmental conditions ranging from 200 feet of seawater depth to high altitude, gas exchange during diving, the pathophysiology of high altitude pulmonary edema, the effect of anesthesia and postoperative analgesia on pulmonary function and monitoring of tissue oxygenation. Ongoing human studies include the use of fractals to study breathing patterns during environmental and perioperative stress, mechanism
    Thacker

    Julie K. Marosky Thacker

    Associate Professor of Surgery
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