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Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection

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Abstract

Introduction

Both enhanced recovery programs (ERP) and laparoscopy can reduce complications and length of stay (LOS) in colon surgery. We investigated whether ERP further improved the short-term outcomes of scheduled laparoscopic colectomies.

Methods

We performed an audit of all patients undergoing scheduled laparoscopic colon resection between January 2003 and August 2010 in our institution. An ERP including accelerated introduction of oral nutrition, mobilization, pain control, and catheter management was introduced in 2005. Demographic data, intra and postoperative details and 30-day ER visit and readmission rate were collected. We compared LOS and short-term outcomes for patients on the program with those receiving traditional postoperative care using Chi-square and regression models. Data are presented as median [25th, 75th percentile]. Statistical significance was defined as p < 0.05.

Results

136 (46 %) of 297 eligible patients were enrolled in the ERP. At baseline, the two groups had similar demographic characteristics, but patients in the ERP were more likely to have their operation by a colorectal surgeon (p = 0.01). Patients in the ERP ate solids earlier (p < 0.001) and had earlier removal of their urinary catheter (p < 0.001). LOS was 4 [3, 6] days for both groups (p < 0.01), with more patients in the ERP discharged by POD 3 (p < 0.001). After adjusting for other variables, ERP enrolment remained an independent predictor of LOS (p < 0.01), along with age (p < 0.01) and in-hospital complications (p < 0.001). Complication rates were similar between the two groups. Patients in the ERP had significantly fewer ER visits (p = 0.02), but there were no differences in readmission rates.

Conclusion

In patients undergoing scheduled laparoscopic colectomy in a university-based clinical teaching unit, ERP can further reduce length of stay and postoperative ER visits without increasing readmission rates.

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Acknowledgement

The study was funded by a grant from Ethicon Canada.

Disclosures

Nicoleta O. Kolozsvari, Giovanni Capretti, Pepa Kaneva, Amy Neville, Franco Carli, Sender Liberman, Patrick Charlebois, Barry Stein, Melina C. Vassiliou, Gerald M. Fried, Liane S. Feldman have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm E19-117, Montreal, QC, H3G 1A4, Canada

    Nicoleta O. Kolozsvari, Giovanni Capretti, Pepa Kaneva, Amy Neville, Melina C. Vassiliou, Gerald M. Fried & Liane S. Feldman

  2. Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada

    Franco Carli

  3. Department of Surgery, Section of Colorectal Surgery, McGill University Health Centre, Montreal, QC, Canada

    Sender Liberman, Patrick Charlebois & Barry Stein

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  1. Nicoleta O. Kolozsvari
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Correspondence to Liane S. Feldman.

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Kolozsvari, N.O., Capretti, G., Kaneva, P. et al. Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection. Surg Endosc 27, 133–138 (2013). https://doi.org/10.1007/s00464-012-2446-6

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