Impact of weekday surgery on application of enhanced recovery pathway: a retrospective cohort study

Abstract

Objective: To compare the enhanced recovery after surgery (ERAS) protocol compliance and clinical outcomes depending on the weekday of surgery.

Settings: Cohort of consecutive non-selected patients undergoing elective colorectal surgery from January 2012 to March 2015. This retrospective analysis of our prospective database compared patients operated early in the week (Monday and Tuesday) with patients operated in the second half (late: Thursday, Friday).

Primary outcome measures: Compliance with the ERAS protocol, functional recovery, complications and length of stay.

Results: Demographic and surgical details were similar between the early (n=352) and late groups (n=204). Overall compliance with the ERAS protocol was 78% vs 76% for the early and late groups, respectively (p=0.009). Significant differences were notably prolonged urinary drainage and intravenous fluid infusion in the late group. Complication rates and length of stay, however, were not different between surgery on Monday or Tuesday and surgery on Thursday or Friday.

Conclusions: Application of the ERAS protocol showed only minor differences for patients operated on early or late during the week, and clinical outcomes were similar. A fully implemented ERAS programme appears to work also over the weekend.

Keywords: ERAS; complications; enhanced recovery; weekdays.

Figure 1

Components of preoperative, intraoperative and postoperative compliance: enhanced recovery items were handled as dichotomous variables. Recommended omissions were accounted for as compliant, if the measure was not performed; for example, no bowel preparation or no nasogastric tube was documented as being compliant with the pathway. Compliance with individual items was calculated as percentage of compliant patients/total patients. IV, intravenous; OPD, postoperative day; PONV, postoperative nausea and vomiting.