Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates.
OBJECTIVE
Enhanced recovery programmes after colorectal surgery are promoted to minimize complications and expedite recovery, thus reducing length of hospital stay where appropriate and improving the overall standard of patient care. There are few published trials of enhanced recovery programmes in the context of laparoscopic colorectal surgery.


METHODS
Data were prospectively collected on all laparoscopic colorectal resections carried out in our institution from May 2004 to November 2009. An informal move to 48-h discharge was introduced in May 2004 and the official enhanced recovery programme was launched in November 2008. We identified all patients with a primary anastomosis discharged within 3 days of surgery. Early outcomes - leaks, complications, readmission rates and returns to theatre - were analysed.


RESULTS
In all, 606 resections were performed in this period. Median length of stay was 4 (0-52) days. Of these patients, 279 (46%) met the criteria of accelerated discharge by day 3: 2 (0.7%) were discharged on the day of surgery, 70 (25.1%) within 24 h, 116 (41.6%) within 48 h and 91 (32.6%) by 72h. Age was not a significant factor in determining length of stay. Patients undergoing right hemicolectomy were more likely to be discharged by 24 h than those with left-sided anastomoses, and patients having total mesorectal excision resections were more likely to stay 3 days. The readmission rate was 4%, regardless of day of discharge.


CONCLUSIONS
Accelerated discharge is feasible and safe. High readmission rates reported in enhanced recovery programmes after open colorectal surgery have not occurred in our laparoscopic experience.
Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
K J
KJ
Gash
G L
GL
Greenslade
A R
AR
Dixon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods / Q000534:rehabilitation*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000534:rehabilitation*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*