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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
Miller, TE
Thacker, JK
White, WD
Mantyh, C
Migaly, J
Jin, J
Roche, AM
Eisenstein, EL
Edwards, R
Anstrom, KJ
Moon, RE
Gan, TJ
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(12 total)
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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
https://hdl.handle.net/10161/8598
Published Version (Please cite this version)
10.1213/ANE.0000000000000206
Publication Info
Miller, TE; Thacker, JK; White, WD; Mantyh, C; Migaly, J; Jin, J; ... Gan, TJ (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 https://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

Adjunct Professor in the Department of Biostatistics & Bioinformatics
My research interests include clinical trial design, causal inference, coordinating centers, data monitoring, and pragmatic clinical research.

Eric Leo Eisenstein

Associate Professor Emeritus in Medicine
Research Interests: Dr. Eisenstein is a member of the Duke Clinical Research Institute&#8217;s Outcomes Research and Assessment Group, with a special interest in understanding the relationships between complex interventions in health care systems and the long-term clinical and economic outcomes of patients. He has served as Principal Investigator for phase II, III, and IV economic and quality of life studies conducted alongside randomized clinical trials in cardiovascular, emerge

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
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
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

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 during challenging clinical settings including the perioperative period, and exposure to environmental conditions such as diving and high altitude. Studies have included gas exchange during diving, the pathophysiology of high altitude and immersion pulmonary edema, the effect of anesthesia and postoperative analgesia on pulmonary function and monitoring of tissue oxygenation. Ongoing human studies include the effect of
Thacker

Julie K. Marosky Thacker

Associate Professor of Surgery
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