Abstract
Background
The aim of this study was to compare the outcome of an enhanced recovery after surgery (ERAS) pathway with traditional perioperative care in laparoscopic rectal resection.
Methods
A retrospective analysis of prospectively collected data was conducted. Single-center consecutive patients who underwent laparoscopic rectal surgery after an ERAS program were compared with patients who received traditional care over an 8-year period. Primary and total length of stay, and readmission, morbidity and mortality rates were analyzed. For ERAS group, the actual adherence to protocol was also evaluated.
Results
Two hundred and ninety-seven patients, 162 in the ERAS group and 135 in conventional care, were studied. Median primary and total length of stay were significantly shorter in the ERAS group (9 vs 12 days; p = 0.0001; 10 vs 12 days; p = 0.01; respectively). The ERAS group experienced a faster recovery of bowel function than the traditional care group (p = 0.0001). A similar morbidity rate was observed in the two groups (32.3 % in ERAS vs 36.1 % in traditional care p = 0.41). Readmission rates were 4.9 % in the ERAS versus 1.5 % in the traditional care group (p = 0.19). There was no mortality in either group. Overall mean compliance with the ERAS protocol was 85.7 % (range 54.4–100 %).
Conclusions
The introduction of the ERAS protocol in laparoscopic rectal resection led to a reduction in primary and total length of hospital stay without an increase in morbidity or readmission rates when compared to traditional care.
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References
Bardram I, Foch-Jensen P, Jensen P, Crawford ME, Koehler H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition an mobilization. Lancet 345:763–764
Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678
Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635
Ren L, Zhu D, Wei Y et al (2012) Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg 36:407–414
ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159
Lassen K, Soop M, Nygren J et al (2009) Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144:961–969
Kim DW, Kang SB, Lee SY, Oh HK, In MH (2013) Early rehabilitation programs after laparoscopic colorectal surgery: evidence and criticism. World J Gastroenterol 19:8543–8551
Lindsetmo RO, Champagne B, Delaney C (2009) Laparoscopic rectal resections and fast-track surgery: What can be expected? Am J Surg 197:408–412
Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453
Vlug MS, Wind J, Hollmann MW et al (2011) Collaborative LAFA Study Group laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 25:868–875
Huibers CJ, de Roos MA, Ong KH (2012) The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 27:751–757
Lee SM, Kang SB, Jang JH et al (2013) Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial. Surgical Endosc 27:3902–3909
Chen CC, Huang IP, Liu MC, Jian JJ, Cheng SH (2011) Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery? Surg Endosc 25:1477–1483
Teeuwen PH, Bleichrodt RP, de Jong PJ, van Goor H, Bremers AJ (2011) Enhanced recovery after surgery versus conventional perioperative care in rectal surgery. Dis Colon Rectum 54:833–839
Bona S, Molteni M, Rosati R et al (2014) Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol 14:17578–17587
Bianchi PP, Rosati R, Bona S et al (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50:2047–2053
Delaney CP, Kehlet H, Senagore A et al (2006) Clinical consensus update® in general surgery, postoperative ileus: profiles, risk factors and definition: a framework for optimizing surgical outcomes in patients undergoing major abdominal and colorectal surgery. Clinical Consensus Update in General Surgery. http://www.clinicalwebcasts.com
Anderin K, Gustafsson UO, Thorell A, Nygren J (2015) The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program. Eur J Surg Oncol 41:724–730
Li XH, Shi H, Wu GS, Zhang HW, Liu XN, Zhao QC (2014) Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients: a randomized controlled clinical trial. J Dig Dis 15:306–313
Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X (2012) Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis 14:1009–1013
Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H (2012) Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 14:769–775
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljunqvist O, Lobo DN (2010) The enhanced recovery after surgery pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440
National Bowel Cancer Audit Annual Report (2013). http://www.hqip.org.uk
Tsai TC, Orav EJ, Jha AK (2015) Patient satisfaction and quality of surgical care in US hospitals. Ann Surg 261:2–8
Francis NK, Mason J, Salib E et al (2015) Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis 17:148–154
Lyon A, Solomon MJ, Harrison JD (2014) A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. Word J Surg 38:1374–1380
Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Enhanced Recovery After Surgery Study Group. adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577
Acknowledgments
We thank Miss Sharon O Neill for her help in reviewing the English language of the manuscript and Giovanni Radaelli MD, PhD from Department of Biometry and Statistics of the University of Milan for his contribution.
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All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained form all individual participant included in the study.
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Vignali, A., Elmore, U., Cossu, A. et al. Enhanced recovery after surgery (ERAS) pathway vs traditional care in laparoscopic rectal resection: a single-center experience. Tech Coloproctol 20, 559–566 (2016). https://doi.org/10.1007/s10151-016-1497-4
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DOI: https://doi.org/10.1007/s10151-016-1497-4