title: Factors predicting deviation from an enhanced recovery programme and delayed discharge after laparoscopic colorectal surgery.
abstract: OBJECTIVE
  The study aimed to identify factors that predict postoperative deviation from an enhanced recovery programme (ERP) and/or delayed discharge following colorectal surgery.
  
  
  METHODS
  Data were prospectively collected from all patients undergoing elective laparoscopic colorectal resection between January 2006 and December 2009. They included Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) variables, body mass index (BMI), sex, preoperative serum albumin, pathology, conversion from a laparoscopic to an open approach and postoperative length of hospital stay.
  
  
  RESULTS
  There were 176 patients (90 women) of mean age 68 years. Fifteen (9%) operations were converted from laparoscopic to open. The remainder were completed laparoscopically. Fifty-five (31%) deviated from the ERP, with most failing multiple elements. The most common reason was failure to mobilize, which often occurred in conjunction with paralytic ileus or analgesic failure. Factors independently predicting ERP deviation on multivariate analysis were pathology and intra-operative complications. The median length of stay was 5 days. Sixty-four (36%) patients had a prolonged length of stay that was predicted by age, number of procedures and ERP deviation.
  
  
  CONCLUSIONS
  Pathology and intra-operative complications are independent predictors of ERP deviation. Prolonged length of stay can be predicted by age, multiple procedures and ERP deviation. Failure to mobilize should be considered as a red flag sign prompting further investigation following colorectal resection.
authors.affiliation: Department of Research and Development, Yeovil District Hospital, Yeovil, Somerset, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Boulind
authors.forename: M
authors.initials: M
authors.lastname: Yeo
authors.forename: C
authors.initials: C
authors.lastname: Burkill
authors.forename: A
authors.initials: A
authors.lastname: Witt
authors.forename: E
authors.initials: E
authors.lastname: James
authors.forename: P
authors.initials: P
authors.lastname: Ewings
authors.forename: R H
authors.initials: RH
authors.lastname: Kennedy
authors.forename: N K
authors.initials: NK
authors.lastname: Francis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D019990:Perioperative Care / Q000379:methods*; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult