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Patients’ refusal as major limitation of early discharge after colorectal resection in an enhanced recovery program

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Abstract

Purpose

The reduction of length of hospitalization without compromising the patient’s safety constitutes the challenge of the enhanced recovery after surgery (ERAS) programs. Our aim was to evaluate the feasibility and safety of a 3-day hospitalization after colectomy and 5-day hospitalization after proctectomy in the setting of an ERAS program.

Methods

An ERAS program was prospectively proposed to all patients who required a colorectal resection (January 2014–December 2018) with a 3- or 5-day discharge objective. The success of the program was defined by a 3-/5-day hospitalization without complications and without readmissions.

Results

Among 283 patients included, 232 patients had a colectomy (82%) and 51 (18%) patients a proctectomy. Eighty-six patients experienced complications (30%) including fifteen severe complications (5%). Mean hospital stay was 5.1 ± 3.7 (2–33) days. A total of 136 patients (48%) were discharged at 3-/5-day, within 9 were readmitted (3%). Discharge was delayed after 3-/5-day for complications (n = 65, 23%), CRP > 120 (n = 45, 16%) or refusal without medical reason (n = 37, 13%). The success rate of the program was 45% (n = 127). This success rate was similar between colectomy and proctectomy (p = 0.277) and between right and left colectomy (p = 0.450). In multivariate analysis, predictive factors associated with the program success were intraoperative use of lidocaine (OR 2.1 [1.1–4.1], p = 0.022), time to remove perfusion ≤ 2 days (OR 10.3 [5.4–19.6], p = 0.001), time to recover bowel movement ≤ 2 days (OR 4.0 [1.7–9.6], p = 0.002) and time to walk out of the room ≤ 2 days (OR 2.6 [1.1–6.0], p = 0.022).

Conclusion

Integrating a realistic hospitalization duration objective into an ERAS program guarantees its safety, feasibility and effectiveness in reducing hospitalization duration.

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Acknowledgements

The authors would like thank Marie-Pierre LEPAVEC for her help as ERAS coordination nurse in the department.

Author information

Author notes

  1. Maxime K. Collard and Morgan Anyla contributed equally to this work.

Authors and Affiliations

  1. Department of Digestive and General Surgery, Hospital Saint-Antoine, Sorbonne University, Paris. Hôpital Saint-Antoine, Paris, France

    Maxime K. Collard, Morgan Anyla, Jérémie H. Lefevre, Anaïs Laforest & Yann Parc

  2. Sorbonne Université, Paris, France

    Jérémie H. Lefevre, Christophe Gutton, Thomas Lescot & Yann Parc

  3. Mater Misericordiae University Hospital, Dublin, Ireland

    Conor Shields

  4. Department of Anaesthesiology, Hospital Saint-Antoine, Sorbonne University, Paris. Hôpital Saint-Antoine, Paris, France

    Christophe Gutton & Thomas Lescot

Authors
  1. Maxime K. Collard
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  2. Morgan Anyla
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  3. Jérémie H. Lefevre
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Contributions

Study conception and design: JHL, YP, TL. Acquisition of data: MKC, MA, AL, CG. Analysis and interpretation of data: MKC, MA, JHL. Drafting of manuscript: MKC, MA, JHL, CS, TL, YP. Critical revision of manuscript: all authors.

Corresponding author

Correspondence to Jérémie H. Lefevre.

Ethics declarations

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Collard, M.K., Anyla, M., Lefevre, J.H. et al. Patients’ refusal as major limitation of early discharge after colorectal resection in an enhanced recovery program. Langenbecks Arch Surg 405, 337–344 (2020). https://doi.org/10.1007/s00423-020-01879-y

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  • DOI: https://doi.org/10.1007/s00423-020-01879-y

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