A Clinical Pathway to Accelerate Recovery After Colonic Resection

Abstract

A multimodal rehabilitation program may significantly reduce the postoperative hospital stay in high-risk patients undergoing colonic resection. Such a program may also reduce postoperative ileus and cardiopulmonary complications. These results may have important implications for the care of patients after colonic surgery and in the future assessment of open versus laparoscopic colonic resection.

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

“…The ERP is a comprehensive perioperative CRS care pathway that has been shown to reduce postoperative morbidity and length of hospitalization. [9][10][11][12][13][14][15][16][17] Similarly, the SSIB is a perioperative care program that systematically provides evidence-supported measures for surgical wound infection prevention and has been shown to reduce the rate of postoperative wound infection. [18][19][20][21][22] Although both the ERP and SSIB have individually been shown to improve outcomes after CRS, the effect of their combined presence has not, to our knowledge, previously been reported in the literature.…”

Benchmarking of aggregated length of stay after open and laparoscopic surgery for cancers of the digestive system

“…An obvious finding in the present study was that across the range of gastrointestinal cancer surgery a‐LOS was much longer than LOS reported in RCTs or single‐centre series4 5, 15. Seminal series have showed that open colectomy stays can be reduced to 2 days4, and laparoscopic surgery to just 23 h 5 .…”

“…Seminal series have showed that open colectomy stays can be reduced to 2 days4, and laparoscopic surgery to just 23 h 5 . Although these may have been intended as ‘proof of principle’, the present data showed a median a‐LOS of 8 days for open and 5 days for laparoscopic colonic resections.…”

“…Postoperative length of hospital stay (LOS) is a readily available surrogate endpoint, often assumed to be a measure of recovery, although open to criticism3. The focus on financial savings with the emergence of laparoscopic approaches to gastrointestinal surgery has nevertheless consolidated a focus on LOS as a meaningful outcome, especially when it is shorter than anticipated4 5. Importantly, transfers of care within or between healthcare facilities and readmissions should be accounted for, especially when the planned duration of the index stay is short.…”

“…Importantly, transfers of care within or between healthcare facilities and readmissions should be accounted for, especially when the planned duration of the index stay is short. Available data, however, tend to be derived from trials and academic centre series, and fail to consider resource issues that influence LOS in the average hospital, or exclude elderly patients and those with major co‐morbidities4, 5, 6, 7, 8.…”