Techniques in Coloproctology

, Volume 22, Issue 3, pp 191–199 | Cite as

The impact of complications after elective colorectal resection within an enhanced recovery pathway

  • L. Lee
  • S. Liberman
  • P. Charlebois
  • B. Stein
  • P. Kaneva
  • F. Carli
  • L. S. Feldman
Original Article
  • 111 Downloads

Abstract

Background

Despite the implementation of enhanced recovery pathways (ERP), morbidity following colorectal surgery remains high. The aim of the present study was to estimate the impact of postoperative complications on excess hospital length of stay (LOS) in patients undergoing elective colorectal resection.

Methods

A retrospective study of patients undergoing elective colorectal surgery at a single institution from 2003 to 2010 was performed. Patients managed by an ERP were compared to conventional care (CC), matched by propensity score radius matching. Complications were defined a priori. Excess (independent effect on LOS from multivariate analysis) and attributable (absolute number of additional bed days) LOS of common postoperative complications determined the impact of complications on bed utilization. Multivariate analysis was performed using multiple linear regression.

Results

A total of 810 propensity-score-matched patients were included (ERP = 472, CC = 338). Complications were significantly lower in the ERP group compared to the CC group (20 vs. 31%, p < 0.001). Median LOS decreased from 7 days in the CC group to 5 days in the ERP group [adjusted decrease in mean LOS of 2.8 days (95% CI 0.8, 4.8)]. Anastomotic leak, myocardial infarction and C. difficile infection had the highest excess LOS for both the ERP and CC groups. However, impaired gastrointestinal function had a higher impact on the absolute number of hospital bed days in the ERP group, as high as anastomotic leak (72.7 vs. 73.5 days respectively), while in the CC group the impact of gastrointestinal dysfunction was less of that of anastomotic leak (50.6 vs. 78.9 days respectively).

Conclusions

In the setting of an ERP, postoperative complications have significant impact on total bed utilization. Impaired gastrointestinal function, given its high incidence, accounted for almost the same number of additional hospital bed days as anastomotic leak in the ERP group and is a target for quality improvement.

Keywords

Treatment outcome Epidemiology Enhanced recovery pathway Preoperative care Length of stay Postoperative complications 

Notes

Acknowledgements

Salary support for LL was provided by the Fonds de Recherche en Santé—Québec and the McGill Surgeon Scientist program.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the institutional review board.

Informed consent

For this type of study formal consent is not required.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • L. Lee
    • 1
    • 2
  • S. Liberman
    • 1
    • 2
  • P. Charlebois
    • 1
    • 2
  • B. Stein
    • 1
    • 2
  • P. Kaneva
    • 1
  • F. Carli
    • 1
    • 3
  • L. S. Feldman
    • 1
  1. 1.Department of Surgery, Steinberg-Bernstein Centre for Minimally-Invasive Surgery and InnovationMcGill University Health CentreMontrealCanada
  2. 2.Section of Colorectal Surgery, Department of SurgeryMcGill University Health CentreMontrealCanada
  3. 3.Department of AnaesthesiaMcGill UniversityMontrealCanada

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