title: Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways.
abstract: BACKGROUND
  Learning curves and efficiency concerns have slowed the integration of laparoscopy into colorectal practice. We evaluated our experience with laparoscopic colorectal (LC) surgery using enhanced recovery pathways (ERPs).
  
  
  METHODS
  One thousand consecutive LC procedures performed by 2 surgeons over a 5-year period using previously published, standardized ERPs were assessed.
  
  
  RESULTS
  The mean age was 59, and the mean body mass index was 29.5. Procedures included segmental colectomy (54%), proctectomy (19%), total colectomy (11%), ostomy (5%), and other procedures (11%). Diagnoses included malignancy (41%), diverticulitis (16%), inflammatory bowel disease (13%), and other (30%). The mean operative time was 151 minutes, and the mean blood loss was 55 mL. Conversion to an open surgery occurred in 5.8%, whereas 2.3% were performed using a hand-assist procedure. The mean hospital stay was 4.1 days (median 3), with a 6% readmission rate. Complications (20%) included mortality (0.3%), wound infection (4%), and anastomotic leak (1.4%).
  
  
  CONCLUSIONS
  LC surgery with ERP offers excellent outcomes with efficient use of resources.
authors.affiliation: Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA. conor.delaney@UHhospitals.org
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Karen
authors.initials: K
authors.lastname: Brady
authors.forename: Donya
authors.initials: D
authors.lastname: Woconish
authors.forename: Stavan P
authors.initials: SP
authors.lastname: Parmar
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Champagne
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods / Q000592:standards; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000379:methods / Q000592:standards; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012002:Rectal Diseases / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome