The benefit of an enhanced recovery programme following elective laparoscopic sigmoid colectomy.
BACKGROUND
Enhanced recovery programmes (ERPs) have demonstrated reduced morbidity and length of hospital stay in patients undergoing open elective colorectal resections. The application of laparoscopic techniques to colorectal surgery is associated with shorter length of stay and morbidity compared to open resections. In the setting of laparoscopic surgery, it is unclear whether there is an additive effect on length of stay and morbidity by combining these. The current study addresses the benefit of an ERP (RAPID protocol) in a cohort of matched patients undergoing laparoscopic sigmoid colon resection


METHODS
Consecutive patients over a 40-month period who underwent laparoscopic sigmoid colon resection were assigned either to the RAPID protocol (group 1) or traditional post operative care (group 2) in a non-randomised manner. Analysis was on an "intention to treat" basis. Primary and secondary endpoints were identified; primary endpoints included length of hospital stay and readmission rate. Secondary endpoints included morbidity and mortality rate.


RESULTS
Seventy-three consecutive patients were included. Group 1 included 37 patients. Group 2 included 36 patients. Median length of hospital stay in groups 1 and 2 was 5 and 8 days, respectively (p = 0.01). Readmission rate in groups 1 and 2 was 8.1% and 8.3%, respectively (p = 0.98). Morbidity rate in groups 1 and 2 was 30% and 22%, respectively (p = 0.61); there was one mortality in each group.


CONCLUSIONS
The application of the ERP (RAPID) to patients undergoing laparoscopic sigmoid colon resection results in a significant improvement in length of hospital stay, with comparable morbidity and readmission rates.
Al Chalabi
Hasan
H
Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland.
Kavanagh
Dara O
DO
Hassan
Lana
L
Donnell
Kate O
KO
Nugent
Emmeline
E
Andrews
Emmet
E
Keane
Frank B V
FB
O'Riordain
Diarmuid S
DS
Miller
Andrew
A
Neary
Paul
P
D003082:Colectomy / Q000379:methods* / Q000401:mortality; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D020127:Recovery of Function