Surgical Endoscopy

, Volume 24, Issue 6, pp 1434–1439 | Cite as

The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections

  • G. M. Lloyd
  • R. Kirby
  • D. M. Hemingway
  • F. B. Keane
  • A. S. Miller
  • P. Neary
Article

Abstract

Background

Enhanced recovery after surgery (ERAS) programs can accelerate recovery and shorten the hospital stay after colorectal resections. The RAPID (remove, ambulate, postoperative analgesia, introduce diet) protocol is a simplified ERAS program that consists of a simplified, user-friendly single-page pro forma schedule. This study aimed to evaluate the impact of the RAPID protocol on patients undergoing both laparoscopic and open colorectal resections in two specialized colorectal units.

Methods

A prospective, two-center study assessed 117 age-matched patients undergoing open or laparoscopic colorectal resection to compare the postoperative course for patients using the RAPID protocol with those treated in a traditional manner.

Results

Of the 117 patients studied, 70 underwent laparoscopic resection (55 with the RAPID protocol) and 47 underwent open resection (25 with the RAPID protocol). Patients undergoing laparoscopic resections with the RAPID protocol had a significantly shorter hospital stay (p = 0.01) and tolerance of a full diet (p = 0.002). Similarly, patients undergoing open resections with the RAPID protocol also have a significantly shorter hospital stay (p = 0.04).

Conclusion

The RAPID protocol is a user-friendly, easy, and effective tool that facilitates earlier tolerance of diet and discharge from the hospital for patients undergoing laparoscopic or open colorectal resections.

Keywords

Colorectal ERAS Fast track Laparoscopic Rapid Surgery 

References

  1. 1.
    Kehlet H (2006) Future perspectives and research initiatives in fast-track surgery. Langenbecks Arch Surg 391:495–498CrossRefPubMedGoogle Scholar
  2. 2.
    Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641CrossRefPubMedGoogle Scholar
  3. 3.
    Vlug MS, Wind J, van der Zaag E, Ubbink DT, Cense HA, Bemelman WA (2009) Systematic review of laparoscopic versus open colonic surgery within an enhanced recovery programme. Colorectal Dis 11:335–343CrossRefPubMedGoogle Scholar
  4. 4.
    Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388CrossRefPubMedGoogle Scholar
  5. 5.
    Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124CrossRefPubMedGoogle Scholar
  6. 6.
    Levy BF, Tilney HS, Dowson HM, Rockall TA (2009) A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Colorectal Dis. Epub ahead of print February 7Google Scholar
  7. 7.
    Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198CrossRefPubMedGoogle Scholar
  8. 8.
    Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA (2007) Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 24:441–449CrossRefPubMedGoogle Scholar
  9. 9.
    Basse L, Jakobsen DH, Bardram L, Billesbølle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423CrossRefPubMedGoogle Scholar
  10. 10.
    Ridgway PF, Boyle E, Keane FB, Neary P (2007) Laparoscopic colectomy is cheaper than conventional open resection. Colorectal Dis 9:819–824CrossRefPubMedGoogle Scholar
  11. 11.
    Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH (2001) “Fast track” postoperative management protocol for patients with high comorbidity undergoing complex abdominal and pelvic colorectal surgery. Colorectal Dis 44:1590–1596Google Scholar
  12. 12.
    Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150PubMedGoogle Scholar
  13. 13.
    Leung KL, Lai PB, Ho RL, Meng WC, Yiu RY, Lee JF, Lau WY (2000) Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg 231:506–511CrossRefPubMedGoogle Scholar
  14. 14.
    Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766CrossRefPubMedGoogle Scholar
  15. 15.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192CrossRefPubMedGoogle Scholar
  16. 16.
    Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMedGoogle Scholar
  17. 17.
    Bokey EL, Chapuis PH, Fung C, Hughes WJ, Koorey SG, Brewer D, Newland RC (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–486CrossRefPubMedGoogle Scholar
  18. 18.
    Basse L, Hjort Jakobsen D, Billesbølle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57CrossRefPubMedGoogle Scholar
  19. 19.
    Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138:252–256CrossRefPubMedGoogle Scholar
  20. 20.
    Cheatham ML, Chapman WC, Key SP, Sawyers JL (1995) A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 221:469–476CrossRefPubMedGoogle Scholar
  21. 21.
    Zargar-Shoshtari K, Connolly AB, Israel LH, Hill AG (2008) Fast-track surgery may reduce complications following major colonic surgery. Dis Colon Rectum 51:1633–1640CrossRefPubMedGoogle Scholar
  22. 22.
    Soop M, Carlson GL, Hopkinson J, Clarke S, Thorell A, Nygren J, Ljungqvist O (2004) Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg 91:1138–1145CrossRefPubMedGoogle Scholar
  23. 23.
    Wind J, Hofland J, Preckel B, Hollmann MW, Bossuyt PM, Gouma DJ, van Berge Henegouwen MI, Fuhring JW, Dejong CH, van Dam RM, Cuesta MA, Noordhuis A, de Jong D, van Zalingen E, Engel AF, Goei TH, de Stoppelaar IE, van Tets WF, van Wagensveld BA, Swart A, van den Elsen MJ, Gerhards MF, de Wit LT, Siepel MA, van Geloven AA, Juttmann JW, Clevers W, Bemelman WA (2006) Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial). BMC Surg 6:16CrossRefPubMedGoogle Scholar
  24. 24.
    Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD (2002) ACPGBI Colorectal Cancer Study 2002: part A. Unadjusted outcomes. Association of Coloproctology of Great Britain and Ireland, June 2002Google Scholar
  25. 25.
    Maessen JM, Dejong CH, Kessels AG, von Meyenfeldt MF, Enhanced Recovery After Surgery (ERAS) Group (2008) Length of stay: an inappropriate readout of the success of enhanced recovery programs. World J Surg 32:971–975CrossRefPubMedGoogle Scholar
  26. 26.
    Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, Kessels AG, Revhaug A, Kehlet H, Ljungqvist O, Fearon KC, von Meyenfeldt MF (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • G. M. Lloyd
    • 1
  • R. Kirby
    • 2
  • D. M. Hemingway
    • 1
  • F. B. Keane
    • 2
  • A. S. Miller
    • 1
  • P. Neary
    • 2
  1. 1.Department of SurgeryLeicester Royal Infirmary, Infirmary SquareLeicesterUK
  2. 2.Minimally Invasive Surgery Tallaght, Division of Colorectal SurgeryAdelaide and Meath HospitalDublinIreland

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