Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.
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 articleSubject
AdultAged
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
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https://hdl.handle.net/10161/8598Published Version (Please cite this version)
10.1213/ANE.0000000000000206Publication 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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Show full item recordScholars@Duke
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’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.
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
John Migaly
Associate Professor of Surgery
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.
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
Julie K. Marosky Thacker
Associate Professor of Surgery
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