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Comparative Study
. 2016 Sep;30(9):4019-28.
doi: 10.1007/s00464-015-4714-8. Epub 2015 Dec 22.

Newly implemented enhanced recovery pathway positively impacts hospital length of stay

Thomas D Martin  1 , Talya Lorenz  1 , Jane Ferraro  1 , Kevin Chagin  2 , Richard M Lampman  1 , Karen L Emery  1 , Joan E Zurkan  1 , Jami L Boyd  1 , Karin Montgomery  1 , Rachel E Lang  1 , James F Vandewarker  1 , Robert K Cleary  3
Affiliations
Comparative Study

Newly implemented enhanced recovery pathway positively impacts hospital length of stay

Thomas D Martin et al. Surg Endosc. 2016 Sep.

Abstract

Background: Enhanced recovery pathways (ERPs) are thought to improve surgical outcomes by standardizing perioperative patient care established in evidence-based literature. The objective of this study was to determine the impact of a colorectal surgery ERP on hospital length of stay (LOS) and other patient outcomes.

Methods: This is a comparative effectiveness study of patients undergoing elective colorectal surgery 2 years prior (pre-ERP group) and 2 years after (ERP group) implementation of an ERP program. The primary outcome was hospital LOS. Secondary outcomes included postoperative complications, 30-day readmissions, and 30-day reoperations. Multivariable regression analyses were utilized to control for patient factors, general health factors, diagnosis, surgeon, colon versus rectal operations, and open versus minimally invasive operations-laparoscopic and robotic. An ERP checklist was developed to track adherence to components of the pathway.

Results: The study population included 1036 patients: 523 in the pre-ERP group and 513 in the ERP group. Unadjusted LOS was significantly shorter in the ERP group than the control pre-ERP group [3 (IQR 3.5) vs 5 days (IQR 4.6); p < 0.0001]. Multivariable regression analysis confirmed the reduction in LOS, controlling for age, colon/rectum procedure, open/laparoscopic/robotic approach, primary diagnosis, and alvimopan use. Postoperative outcomes were not significantly different between groups except for 30-day readmissions, which were unexpectedly higher in the ERP group (14.6 vs 8.7 %, p = 0.04).

Conclusions: A newly implemented ERP on a dedicated colorectal surgery service in an academic non-university hospital setting resulted in shorter hospital LOS, but increased readmissions, for patients undergoing elective open and minimally invasive colon and rectal surgery. Future multi-institutional studies are needed to understand the impact of ERP on postoperative complications and readmissions.

Keywords: Enhanced recovery after surgery; Enhanced recovery pathway; Fast-track surgery; Minimally invasive colorectal surgery; Quality improvement.

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References

    1. Clin Colon Rectal Surg. 2013 Sep;26(3):139-45 - PubMed
    1. Clin Nutr. 2015 Jun;34(3):367-76 - PubMed
    1. N Z Med J. 2010 Jul 30;123(1319):61-70 - PubMed
    1. JAMA Surg. 2014 Sep;149(9):955-61 - PubMed
    1. Surg Endosc. 2013 Jan;27(1):133-8 - PubMed

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