Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.
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2014-05
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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.
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Miller, TE, JK Thacker, WD White, C Mantyh, J Migaly, J Jin, AM Roche, EL Eisenstein, et al. (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.
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Scholars@Duke
Timothy Ellis Miller
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.
Julie K. Marosky Thacker
Christopher Ritchie Mantyh
Neurogenic inflammation
Ulcerative colitis
Crohn's disease
Neuropeptides
Receptors
Vanilloid receptor
Substance P
Intestinal motility
Colorectal cancer outcomes
Colon cancer
Rectal cancer
Eric Leo Eisenstein
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, emergency, pulmonary, and vascular medicine and surgery. He also has conducted health technology evaluations making use of innovative research methods designed to better understand key relationships in observation (non-randomized) patient data. This work has included evaluations of the long-term clinical outcomes of coronary artery disease patients receiving drug-eluting vs. bare metal intracoronary stents, and how the use of clopidogrel changes those relationships. He also has conducted several studies assessing factors contributing to the costs of and evaluating different design considerations for multi-center randomized clinical trials.
In addition to his working in traditional health technology evaluation, Dr. Eisenstein has an interest in evaluating information technologies as interventions in health care systems. In this regard, he has collaborated in the design and conduct of large-scale, randomized clinical trials to evaluate clinical decision support systems. The research objective in these studies has been to develop methods for evaluating health information technologies in practice-based settings using a “tool kit” of inexpensive, yet highly scalable methods that make use of data sets created as a byproduct of normal clinical and administrative operations. The use of these evaluation methods has been demonstrated in four clinical trials that include care process, clinical, economic, and quality of life measurements.
Kevin J. Anstrom
My research interests include clinical trial design, causal inference, coordinating centers, data monitoring, and pragmatic clinical research.
Richard Edward Moon
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 respiratory muscle training on chemosensitivity and blood gases during stressful breathing: underwater exercise.
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