title: Enhanced recovery in major colorectal surgery: safety and efficacy in an unselected surgical population at a UK district general hospital.
abstract: BACKGROUND
  Enhanced Recovery Programmes (ERPs) have been shown to benefit recovery following major surgery in selected centres and patient groups, but their wider applicability requires continued evaluation. The aims of this study were to assess the outcomes of the first 400 consecutive, non-selected patients, undergoing major elective colorectal surgery within an Enhanced Recovery programme at a UK District General hospital and to examine the effects of patient risk factors and operative approach on outcomes.
  
  
  METHODS
  Since September 2005 all patients undergoing major elective colon and rectal surgery at our hospital have been treated within an ERP and their data recorded prospectively on a database. Safety and efficacy outcomes for the first 400 patients were compared using SPSS v14.0 with both a retrospective, pre-ERP group; and according to patient risk factors and operative approaches.
  
  
  RESULTS
  Median length of stays (LOS) reduced from 9 days (IQR 7-11) to 6 days (IQR 5-10) after introduction of the ERP (p < 0.001). No statistically significant differences in LOS were observed between elderly (≥80 years) and younger patients or between different BMI groups. American Society of Anesthesiologists (ASA) grade 3 patients demonstrated significantly longer median LOS than those with ASA grades 1 and 2. Patients undergoing laparoscopic surgery had median LOS of 6 days (IQR 4-8) compared to 7 days (IQR 5-10) for open procedures (p < 0.001). No differences in morbidity or mortality were observed between the groups.
  
  
  CONCLUSIONS
  Unselected application of an ERP in our unit has been associated with reductions in post-operative LOS. The ERP was safe and effective when applied to all our study patients independent of age and BMI. Despite LOS being longer in ASA grade 3 patients, application of the ERP to this higher risk group was not associated with significantly increased morbidity or mortality. Laparoscopic surgery resulted in additional modest reductions in LOS compared to open surgery within the ERP.
authors.affiliation: Department of Colorectal Surgery, Torbay Hospital, Lawes Bridge, Torquay TQ2 7AA, UK. katiewaltersouthafrica@googlemail.com
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Walter
authors.forename: Jane T
authors.initials: JT
authors.lastname: Watson
authors.forename: Rupert D
authors.initials: RD
authors.lastname: Pullan
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kenefick
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Mitchell
authors.forename: David J
authors.initials: DJ
authors.lastname: Defriend
mesh_terms: D000368:Aged; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D019091:Critical Pathways; D017558:Elective Surgical Procedures; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom