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The ERAS protocol reduces the length of stay after laparoscopic colectomies

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Abstract

Background

The Enhanced Recovery After Surgery (ERAS) protocol, which is developed to enhance postoperative recovery of patients treated with open colorectal surgery, has been widely adopted. The ERAS protocol has also been introduced in patients treated with laparoscopic colectomy, without data to support its additional value. We investigated whether laparoscopic colectomy in combination with the use of the ERAS protocol leads to a reduction of postoperative length of stay compared to laparoscopic colectomy with conventional care.

Methods

We performed a comprehensive medical record review. Inclusion criteria were patients who had undergone a laparoscopic colectomy at a single center between April 2004 and September 2009 (n = 186). The ERAS protocol had been introduced at the end of 2006. We divided the patients in a pre-ERAS group (n = 77), and an ERAS group (n = 109). We compared the baseline characteristics of both groups. The primary outcome was postoperative length of stay.

Results

We did not find significant differences in gender, age, body mass index (BMI), diabetes mellitus (DM), American Society of Anesthesiologists (ASA) classification, and diagnosis and type of surgery between the two groups. Median postoperative length of stay was 6 days (range = 2–28) in the pre-ERAS group and 4 days (range = 2–55) in the ERAS group (P = 0.007). Median return of bowel function was 3 days (range = 1–6) in the pre-ERAS group and 2 days (range = 1–5) in the ERAS group (P < 0.001). We did not find significant differences in postoperative procedure-related complications (wound infection, anastomotic leakage, abscesses), postoperative morbidity, 30-day readmission, 30-day reoperation, and 30-day mortality.

Conclusions

The postoperative length of stay was significantly reduced in the ERAS group without differences in patient outcome. It is suggested that these results are the effect of a combination of the ERAS protocol with laparoscopic colectomy.

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References

  1. Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D (1992) Laparoscopic colectomy. Ann Surg 216:703–707

    Article  PubMed  CAS  Google Scholar 

  2. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  3. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  4. Nelson H, Sargent D, Wieand HS, Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059

    Article  CAS  Google Scholar 

  5. Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Påhlman L (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303

    Article  PubMed  Google Scholar 

  6. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  7. Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859

    Article  PubMed  Google Scholar 

  8. Spanjersberg WR, Reurings J, van Laarhoven CH (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2):CD007635

  9. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198

    Article  PubMed  Google Scholar 

  10. Nygren J, Soop M, Thorell A, Hausel J, Ljungqvist O (2009) An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients. Dis Colon Rectum 52:978–985

    Article  PubMed  Google Scholar 

  11. Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504

    Article  PubMed  CAS  Google Scholar 

  12. Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92:1354–1362

    Article  PubMed  CAS  Google Scholar 

  13. Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767

    Article  PubMed  Google Scholar 

  14. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617

    PubMed  CAS  Google Scholar 

  15. Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345:763–764

    Article  PubMed  CAS  Google Scholar 

  16. Bardram L, Funch Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patients after laparoscopic colonic colonic resection. Br J Surg 87:1540–1545

    Article  PubMed  CAS  Google Scholar 

  17. Raue W, Haase O, Junghans T, Scharfenberg M, Müller JM, Schwenk W (2004) ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 18:1463–1468

    Article  PubMed  CAS  Google Scholar 

  18. 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) (study protocol). BMC Surg 6:16. Available at http://www.biomedcentral.com/1471-2482/6/16

  19. Tsikitis VL, Holubar SD, Dozois EJ, Cima RR, Pemberton JH, Larson DW (2010) Advantages of fast-track recovery after laparoscopic right hemicolectomy for colon cancer. Surg Endosc 24:1911–1916

    Article  PubMed  Google Scholar 

  20. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW (2003) Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 7:558–561

    Article  PubMed  Google Scholar 

  21. Veyrie N, Ata T, Muscari F, Couchard AC, Msika S, Hay JM, Fingerhut A, Dziri C (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 205:785–793

    Article  PubMed  Google Scholar 

  22. Grantcharov TP, Kehlet H (2010) Laparascopic gastric surgery in an enhanced recovery programme. Br J Surg 97:1547–1551

    Article  PubMed  CAS  Google Scholar 

  23. Gralla O, Buchser M, Haas F, Anders E, Kramer J, Lein M, Knoll N, Roigas J (2008) Fast-track laparoscopic radical prostatectomy. Urologe A 47:712–717

    Article  PubMed  CAS  Google Scholar 

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Disclosures

M. P. Haverkamp, M. A. J. de Roos and K. H. Ong have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Rivierenland Hospital Tiel, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands

    M. P. Haverkamp, M. A. J. de Roos & K. H. Ong

  2. PO Box 6024, 4000 HA, Tiel, The Netherlands

    M. A. J. de Roos

Authors
  1. M. P. Haverkamp
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  2. M. A. J. de Roos
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  3. K. H. Ong
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Correspondence to M. A. J. de Roos.

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Haverkamp, M.P., de Roos, M.A.J. & Ong, K.H. The ERAS protocol reduces the length of stay after laparoscopic colectomies. Surg Endosc 26, 361–367 (2012). https://doi.org/10.1007/s00464-011-1877-9

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  • DOI: https://doi.org/10.1007/s00464-011-1877-9

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