Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery

Abstract

BackgroundDespite international data indicating that Enhanced Recovery After Surgery (ERAS) programs, which combine evidence-based perioperative strategies, expedite recovery after surgery, few centers have successfully adopted this approach within the U.S. We describe the implementation and efficacy of an ERAS program for colorectal abdominal surgery in a tertiary teaching center in the U.S.MethodsWe used a multi-modal and continuously evolving approach to implement an ERAS program among all patients undergoing colorectal abdominal surgery at a single hospital at the University of California, San Francisco. 279 patients who participated in the Enhanced Recovery after Surgery program were compared to 245 previous patients who underwent surgery prior to implementation of the program. Primary end points were length of stay and readmission rates. Secondary end points included postoperative pain scores, opioid consumption, postoperative nausea and vomiting, length of urinary catheterization, and time to first solid meal.ResultsERAS decreased both median total hospital length of stay (6.4 to 4.4 days) and post-procedure length of stay (6.0 to 4.1 days). 30-day all-cause readmission rates decreased from 21 to 9.4 %. Pain scores improved on postoperative day 0 (3.2 to 2.1) and day 1 (3.2 to 2.6) despite decreased opioid. Median time to first solid meal decreased from 4.7 to 2.7 days and duration of urinary catheterization decreased from 74 to 46 h. Similar improvements were observed in all other secondary end points.ConclusionsThese results confirm that a multidisciplinary, iterative, team-based approach is associated with a reduction in hospital stay and an acceleration in recovery without increasing readmission rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0223-0) contains supplementary material, which is available to authorized users.

C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

“…The two groups are well‐balanced with no difference in age, sex, or morbidities … Our development of a multidisciplinary, evidence‐based ERAS program at a major tertiary medical centre performing abdominal colorectal surgery was associated with shortened LOS in the univariate analysis. However, despite the preoperative optimization of the patients, according to several articles, our findings did not show a reduction of 30‐days readmission rates, nor the rate of reinterventions or Clavien Dindo complications (Table ).…”

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

“…2,4,11 Specifically, ERAS pathways in gynecologic surgery have reportedly been successful 4,14,15 at addressing the issues thereof, but the results have been limited by relatively small patient populations and the inclusion of study participants with benign disease and data that have primarily reflected observations from academic medical centers. 12,16 In the current investigation, we report our experience in implementing an ERAS protocol with a gynecologic oncology population that was treated in the community hospital setting.…”

“…4,5 Initially, ERAS protocols were primarily instituted in the field of colorectal surgery, 6,7 emphasizing the beneficial use of preoperative medication, limited use of bowel preps, multimodal analgesia, intraoperative fluid restriction, prompt enteral nutrition, and early patient ambulation. 2,4,8Y10 Enhanced recovery after surgery regimens have been employed in gynecologic surgery 4,11 and in Europe, 1,12,13 but scarcely in the community hospital setting.…”

ERAS—Anticipated outcomes and realistic goals

“…This last meta‐analysis also showed a significant decrease in the time to first bowel movement (about 34 h) . In one other study, the median time to first solid meal decreased from 4.7 to 2.7 days with the implementation of the program …”

“…62 In one other study, the median time to first solid meal decreased from 4.7 to 2.7 days with the implementation of the program. 63 Irrespective of the positive results published, some authors have questioned the association between return of bowel function and the enhanced recovery interventions by criticizing the lack of data on compliance in some studies 61 and the variability of definition of enhanced recovery itself. These authors further suggest that LOS is a poor surrogate for recovery because fast-track strategies that are entirely not patient centric can be used to lower LOS.…”