Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?

Abstract

Aim Enhanced recovery after surgery programmes in elective colorectal surgery have been developed and implemented widely, but a subgroup of patients may still require longer hospital stays than expected. The aim of this study was to identify and describe factors compromising early postoperative recovery by asking ‘why is the patient still in hospital today?’ after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery programme. Method Patients undergoing elective laparoscopic colorectal cancer resection were evaluated postoperatively with predefined potential reasons for still being in hospital. The primary outcome was ‘reason for still being in hospital’ on postoperative day 0–4 and secondarily length of stay with a focus on differences between patients with and without a stoma. Results Ninety‐six patients having colorectal cancer surgery were included. The median length of stay for the whole group was 3 days (range 1–14). The four dominant causes for patients without a stoma to be in hospital were lack of gastrointestinal function, lack of early mobilization, lack of normal micturition and nausea. Patients with a stoma stayed in hospital due to stoma training, lack of gastrointestinal function, lack of free micturition and a miscellaneous ‘others’ group. Conclusion Delayed gastrointestinal function, insufficient mobilization, poor urinary function and stoma care training have been characterized as dominant compromising factors for postoperative recovery. Together with a focus on frailty, future studies should focus on improving early mobilization, prevention and treatment of postoperative urinary retention and improved stoma care training, in order to minimize delay in postoperative recovery and discharge.

Use of Machine Learning and Statistical Algorithms to Predict Hospital Length of Stay Following Colorectal Cancer Resection: A South African Pilot Study

“…However, the findings of this study correlated with those of previous studies (8,27,28). Several studies support the relationship between the requirement for a stoma and risk of prolonged hospital LOS (10,27,29). Furthermore, stoma type and length are also associated with prolonged hospital LOS (30).…”

Optimizing Outcomes with Enhanced Recovery

“…High ileostomy output and dehydration readmission rates are reported in up to 15% of these patients. Index admission length of stay among diverted patients has been shown to be prolonged significantly, mitigating the effects of laparoscopy on LOS [58], even in the context of an ERP [59]. With the expected expedited recovery on an ERAS protocol, new ileostomy patients leave the hospital sooner, leaving little time for a patient with a newly formed stoma to learn the practical skills of caring for the stoma.…”

It is Time to Merge Enhanced Recovery Programs and Ambulatory Surgery

“…ERAS and ambulatory surgery are two approaches that have evolved in parallel for several decades. Ambulatory surgery calls for an organizational approach that aims to optimize the stay and ensure that only the strictly useful and necessary time is allotted for its management 3,4 Ambulatory surgery is an economic model that has proved medically virtuous if kept within its limits, and ERAS is a model of quality of care that has proved economically virtuous if it is applied to all patients. In both cases, the involvement and coordination of all medical, paramedical and administrative staff is most important.…”