Cr08
one Year Experience With Fast‐track Surgery for Elective Colonic Resection

Abstract

Purpose Fast‐Track Surgery or Enhanced Recovery After Surgery (ERAS) programs are becoming increasingly common. However there are concerns regarding safety, readmission rates and the impact on overall morbidity. We aimed to compare the results from our ERAS program for elective colonic surgery with those from our institution prior to commencement of ERAS. Method We established an ERAS program for colonic resection at Manukau Surgical Centre (MSC) in Auckland. This included strategies such as epidural analgesia, early feeding and mobilisation. Patients were discharged once they were able to tolerate a full diet, had evidence of return of GI function and pain was managed with oral analgesia. They were followed up within a week. Results From Dec 2005 to Dec 2006, 35 consecutive patients undergoing elective colonic resection at MSC under our ERAS program were studied prospectively. The control group consisted of 35 consecutive patients undergoing colonic resection under conventional care at the same institution prior to Dec 2005. Groups were comparable with respect to physiological and operative CR‐POSSUM scores. Median day stay for the ERAS group was 4 (3–27) compared to 8 (4–30) days for the conventional group (p < 0.001). ERAS was associated with a trend towards an earlier return of gastrointestinal function, reduced rate of infective and pulmonary complications. There were no differences in the readmission rates. Conclusion ERAS is a practical and safe method of managing patients undergoing major colonic surgery and such structured care plans not only reduce hospital stay but may also be associated with reduced immediate post‐operative morbidity.

The Use of Epidural Analgesia in a New Zealand Tertiary Hospital before and after Publication of the Master Study

“…Not only does this appear to benefit patients (although readmission rates are possibly increased) but it is also logical in a healthcare system under increasing fiscal pressure. Indeed, a group from Auckland recently compared patients on an enhanced recovery program with matched historical controls and showed not only a shorter length of stay but also possible improvement in rates of immediate postoperative morbidity 18 .…”