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Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

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Abstract

Objective

The objective of enhanced recovery after surgery (ERAS) programs is to incorporate strategies into the perioperative care plan to decrease complications, hasten recovery, and shorten hospital stay. This study was designed to determine which ERAS strategies contribute to overall shortened length of hospital stay in patients undergoing elective colorectal surgery in hospitals.

Methods

A retrospective cohort study of 336 consecutive patients at seven hospitals was performed. Demographic and data on 18 ERAS components identified from a systematic review of the literature were collected. A multiregression analysis was performed to assess for factors independently associated with a total length of hospital stay of 5 days or less.

Results

Fifty-five percent were male (mean age, 62 years), 57.5% had an ASA III or IV, 76.9% had cancer, and 28.6% had low rectal procedures; 46.3% were completed laparoscopically. The median length of stay was 6.5 days with a mean of 8.6 days. On bivariate analysis, strategies associated with a stay ≤5 days were preoperative counseling, avoidance of oral bowel preparation, use of a laparoscopic approach, use of a transverse incision, introduction of clear fluids on day of surgery, and early discontinuation of the Foley catheter (all P < 0.05). On multivariate analysis, factors that remained significantly associated with a stay ≤5 days included use of a laparoscopic approach (odds ratio (OR), 1.24; 95% confidence interval (CI), 1.12–1.38), preoperative counseling (OR, 1.26; 95% CI, 1.15–1.38), intraoperative fluid restriction (OR, 1.26; 95% CI, 1.15–1.37), clear fluids on day of surgery (OR, 1.09; 95% CI, 1.00–1.2), and Foley urinal catheter discontinued within 24 h of colon surgery and 72 h of rectal surgery (OR, 1.13; 95% CI, 1.01–1.27).

Conclusions

In hospitals with variable uptake of ERAS strategies, preoperative counseling, intraoperative fluid restriction, use of a laparoscopic approach, immediate initiation of clear fluids after surgery, and early discontinuation of the Foley catheter are all independently associated with shortened length of stay.

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Acknowledgement

Supported by a grant from Colon Cancer, Canada.

Disclosures

Drs. Aarts, Okrainec, and McLeod, along with authors Emily Pearsall, Amy Glicksman, and J. Charles Victor, have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, Canada

    Mary-Anne Aarts, Allan Okrainec, Amy Glicksman, Emily Pearsall & Robin S. McLeod

  2. Toronto East General Hospital, 840 Coxwell Avenue, Suite 304, Toronto, ON, M4C 5T2, Canada

    Mary-Anne Aarts

  3. Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

    Robin S. McLeod

  4. Zane Cohen Digestive Diseases Research Center, Mount Sinai Hospital, Toronto, ON, Canada

    Robin S. McLeod

  5. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    Robin S. McLeod

  6. Toronto Western Hospital, University Health Network, Toronto, ON, Canada

    Allan Okrainec

  7. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    J. Charles Victor

  8. DeGasparis Families Chair in IBD and GI Cancer Research, Toronto, Canada

    Robin S. McLeod

Authors
  1. Mary-Anne Aarts
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  2. Allan Okrainec
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  3. Amy Glicksman
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  4. Emily Pearsall
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  5. J. Charles Victor
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  6. Robin S. McLeod
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Corresponding author

Correspondence to Mary-Anne Aarts.

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Aarts, MA., Okrainec, A., Glicksman, A. et al. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surg Endosc 26, 442–450 (2012). https://doi.org/10.1007/s00464-011-1897-5

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  • DOI: https://doi.org/10.1007/s00464-011-1897-5

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