International Journal of Colorectal Disease

, Volume 27, Issue 12, pp 1637–1644 | Cite as

Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection

  • Antonio Arroyo
  • José Manuel Ramirez
  • Daniel Callejo
  • Xavier Viñas
  • Sergio Maeso
  • Roger Cabezali
  • Elena Miranda
  • Spanish Working Group in Fast Track Surgery (GERM)
Original Article



The aim of this study was to see whether the application of the enhanced recovery programme for colorectal resection improves the results and, in turn, the influence of complexity and size of the hospitals in applying this and its results.


A multi-centric prospective study was controlled with a retrospective group. The prospective operation group included 300 patients with elective colorectal resection due to cancer. The centres were divided depending on size and complexity in large reference centres (group 1) and area and basic general hospitals (group 2). The retrospective control group included 201 patients with the same characteristics attended before the application of the programme. Completion of categories of the protocol, complications, perioperative mortality and stay in hospital were recorded.


The introduction of the programme achieved a reduction in mortality (1 vs. 4 %), morbidity (26 vs. 39 %) and preoperative (<24 h vs. 3 days) and postoperative (7 vs. 11 days) stays (p < 0.01). There was greater fulfilment of protocol in group 2 with the mean number of items completed at 8.46 and 60 % completed compared with the hospitals in group 1 (7.70 completed items and 55 % completion). The size of the hospital had no relation to the rate of complications (21.3 vs. 26.5 %). In smaller sized and less complex hospitals, the average length of stay was 1.88 days less than in those of greater size (6.45 vs. 8.33 days).


Patients treated according to an enhanced recovery programme develop significantly fewer complications and have a shorter hospital stay. The carrying out of protocol is greater in smaller and less complex hospitals and is directly related to a shorter stay in hospital.


Enhanced recovery programme Colorectal 


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Antonio Arroyo
    • 1
  • José Manuel Ramirez
    • 2
  • Daniel Callejo
    • 3
  • Xavier Viñas
    • 4
  • Sergio Maeso
    • 3
  • Roger Cabezali
    • 5
  • Elena Miranda
    • 6
  • Spanish Working Group in Fast Track Surgery (GERM)
  1. 1.Coloproctology Unit, Department of SurgeryUniversity Hospital of ElcheElcheSpain
  2. 2.Department of Colorectal SurgeryHospital Clínico Universitario Lozano BlesaZaragozaSpain
  3. 3.Health Technology AssessmentAgencia Laín EntralgoMadridSpain
  4. 4.Department of SurgeryHospital d’IgualadaIgualadaSpain
  5. 5.Department of SurgeryFundación Hospital CalahorraCalahorraSpain
  6. 6.Department of AnesthesiologyUniversity Hospital of ElcheElcheSpain

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