Predictors of length of stay in patients having elective colorectal surgery within an enhanced recovery protocol

Abstract

Background: Enhanced recovery after surgery (ERAS) pathways has been shown to minimize the duration of hospital stay. The aim of this study was to identify which factors have the greatest impact at reducing the length of stay within an enhanced recovery programme.

Methods: A retrospective case note review of patients undergoing open elective colorectal resections between August 2007 and May 2009 was performed. Data on numerous pre, peri and postoperative variables were collected. Postoperative complications, readmissions, length of stay and fitness for discharge were recorded. Using logistic regression analysis, univariate and multivariate analysis of predictors for a shorter hospital stay was performed. Odd ratios and ninety-five percent confidence intervals were calculated and a p-value of less than 0.05 was significant.

Results: There were 231 patients, of which 130 were female. Median age was 68 (IQR 56-76) years. Median length of stay was 6 (IQR 5-9) days. On multivariate analysis, ASA grade (OR 2.85 (95%CI 1.17-6.89), p = 0.040), the avoidance of oral opiates in the postoperative period (OR 0.39 (95%CI 0.18-0.84), p = 0.016) and the duration of use of epidurals for postoperative analgesia (OR 0.44 (95%CI 0.12-0.94), p = 0.023) were found to be significant predictors of reduced hospital stay.

Conclusion: Lower ASA grade, use of epidurals and avoidance of regular oral opiates are associated with an earlier discharge in an ERAS programme.