World Journal of Surgery

, Volume 37, Issue 5, pp 1082–1093 | Cite as

Structured Synchronous Implementation of an Enhanced Recovery Program in Elective Colonic Surgery in 33 Hospitals in The Netherlands

  • Freek Gillissen
  • Christiaan Hoff
  • José M. C. Maessen
  • Bjorn Winkens
  • Jitske H. F. A. Teeuwen
  • Maarten F. von Meyenfeldt
  • Cornelis H. C. Dejong
Article

Abstract

Background

It has been clearly shown that after elective colorectal surgery patients benefit from multimodal perioperative care programs. The Dutch Institute for Health Care Improvement started a breakthrough project to implement a multimodal perioperative care program of enhanced recovery after surgery (ERAS). This pre/post noncontrolled study evaluated the success of large-scale implementation of the ERAS program for elective colonic surgery using the breakthrough series.

Methods

A total of 33 hospitals participated in this breakthrough project during 2005–2009. Each hospital performed a retrospective chart review to gather information on traditionally treated patients (pre-ERAS group, n = 1,451). During the subsequent year patients were treated according to the ERAS program (ERAS group, n = 1 034). Outcomes were length of stay (LOS), functional recovery, adherence to the protocol, and determinants of reduced LOS.

Results

Median LOS decreased significantly from 9 to 6 days (p < 0.001). In the ERAS group, functional recovery was reached within 3 days. Adherence to the protocol elements was high during the preoperative and perioperative phases but slightly lower during the postoperative phase. Younger age, female sex, American Society of Anesthesiologists grades I/II, and laparoscopic surgery were associated with decreased LOS. Care elements that positively influenced LOS were cessation of intravenous fluids and mobilization on postoperative day 1 and administration of laxatives postoperatively.

Conclusions

The ERAS program was successfully implemented in one-third of all Dutch hospitals using the breakthrough series. Participating hospitals reduced the LOS by a median 3 days and were able to improve their standard of care in elective colonic surgery.

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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Freek Gillissen
    • 1
    • 3
    • 5
    • 10
  • Christiaan Hoff
    • 2
  • José M. C. Maessen
    • 4
    • 6
  • Bjorn Winkens
    • 7
  • Jitske H. F. A. Teeuwen
    • 8
  • Maarten F. von Meyenfeldt
    • 1
    • 3
    • 9
  • Cornelis H. C. Dejong
    • 1
    • 9
  1. 1.Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
  2. 2.Department of SurgeryLeeuwarden Medical CentreLeeuwardenThe Netherlands
  3. 3.Department of OncologyGROW, School for Oncology and Developmental Biology, Maastricht University Medical CentreMaastrichtThe Netherlands
  4. 4.Department of Patient and CareMaastricht University Medical CentreMaastrichtThe Netherlands
  5. 5.Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht, University Medical CentreMaastrichtThe Netherlands
  6. 6.Department of General PracticeCAPHRI, School for Public Health and Primary Care, Maastricht University Medical CentreMaastrichtThe Netherlands
  7. 7.Department of Methodology and StatisticsCAPHRI, School for Public Health and Primary Care, Maastricht University Medical CentreMaastrichtThe Netherlands
  8. 8.CBO—Centraal Begeleidings OrgaanDutch Institute for Healthcare ImprovementUtrechtThe Netherlands
  9. 9.Nutrim School for Nutrition, Toxicology, and Metabolism, Maastricht University, Medical CentreMaastrichtThe Netherlands
  10. 10.MaastrichtThe Netherlands

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