The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer.
OBJECTIVE
Optimizing peri-operative care using an enhanced recovery programme improves short-term outcomes following colonic resection. This study compared a prospective group of patients undergoing resection of colorectal cancer within an enhanced recovery programme, with a prospectively studied historic cohort receiving conventional care.


METHODS
Sixty patients underwent elective resection within an enhanced recovery programme (ERP). This incorporated pre-operative counselling, epidural analgesia, early feeding and mobilization. Clinical outcomes were compared with 86 prospectively studied historic control patients receiving conventional care (CC). All patients completed EORTC QLQ-C30, QLQ-CR38 and health economics questionnaires up to three months after surgery.


RESULTS
Baseline clinical data were similar in both groups. Postoperative hospital stay was significantly reduced in the ERP, with patients staying 49% as long as those in the CC group including convalescent hospital stay (95% CI 39% to 61%P < 0.001). There were no differences in the number of complications, readmissions or re-operations. There were no significant differences in quality of life or health economic outcomes.


CONCLUSIONS
Patients undergoing colorectal resection within an ERP stay in hospital half as long as those receiving conventional care, with no increased morbidity, deterioration in quality of life or increased cost.
King
P M
PM
Department of Surgery, Yeovil District Hospital, Yeovil, Somerset, UK.
Blazeby
J M
JM
Ewings
P
P
Longman
R J
RJ
Kipling
R M
RM
Franks
P J
PJ
Sheffield
J P
JP
Evans
L B
LB
Soulsby
M
M
Bulley
S H
SH
Kennedy
R H
RH
D000368:Aged; D002985:Clinical Protocols; D003082:Colectomy / Q000379:methods / Q000534:rehabilitation*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D011182:Postoperative Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D006113:United Kingdom