title: Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model.
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) programmes are well established, but deviation from the postoperative elements may result in delayed discharge. Early identification of such patients may allow remedial action to be taken. The aims of this study were to investigate factors associated with delayed discharge and to produce a predictive scoring system for ERAS failure.
  
  
  METHODS
  A retrospective review was carried out of case notes of patients who underwent elective laparoscopic colorectal resection and ERAS at Yeovil District Hospital between 2002 and 2009. Univariate and multivariate analyses were performed and binary logistic regression was used to model a predictive scoring system.
  
  
  RESULTS
  In all, 385 patient records were reviewed with a median length of stay of 6 days; 122 (31%) patients stayed longer than 1 week (delayed discharge) and 159 (41%) deviated in up to two postoperative ERAS factors. Patient demographic factors were not predictive of delayed discharge. Deviation from ERAS factors at the end of the first postoperative day, including continued intravenous fluid infusion, lack of functioning epidural, inability to mobilize, vomiting requiring nasogastric tube insertion and re-insertion of urinary catheter, were strongly associated with delayed discharge. A five-element predictive scoring system for ERAS failure and delayed discharge was formulated.
  
  
  CONCLUSIONS
  Enhanced recovery failure and delayed discharge after laparoscopic colorectal surgery can be predicted by the early deviation from postoperative factors of an ERAS programme.
authors.affiliation: Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Smart
authors.forename: P
authors.initials: P
authors.lastname: White
authors.forename: A S
authors.initials: AS
authors.lastname: Allison
authors.forename: J B
authors.initials: JB
authors.lastname: Ockrim
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; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000534:rehabilitation*; D017558:Elective Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000534:rehabilitation*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D010351:Patient Discharge; D059035:Perioperative Period; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult