Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection.
BACKGROUND
Both enhanced recovery programs (ERP) and laparoscopy can reduce complications and length of stay (LOS) in colon surgery. We investigated whether ERP further improved the short-term outcomes of scheduled laparoscopic colectomies.


METHODS
We performed an audit of all patients undergoing scheduled laparoscopic colon resection between January 2003 and August 2010 in our institution. An ERP including accelerated introduction of oral nutrition, mobilization, pain control, and catheter management was introduced in 2005. Demographic data, intra and postoperative details and 30-day ER visit and readmission rate were collected. We compared LOS and short-term outcomes for patients on the program with those receiving traditional postoperative care using Chi-square and regression models. Data are presented as median [25th, 75th percentile]. Statistical significance was defined as p < 0.05.


RESULTS
136 (46%) of 297 eligible patients were enrolled in the ERP. At baseline, the two groups had similar demographic characteristics, but patients in the ERP were more likely to have their operation by a colorectal surgeon (p = 0.01). Patients in the ERP ate solids earlier (p < 0.001) and had earlier removal of their urinary catheter (p < 0.001). LOS was 4 [3, 6] days for both groups (p < 0.01), with more patients in the ERP discharged by POD 3 (p < 0.001). After adjusting for other variables, ERP enrolment remained an independent predictor of LOS (p < 0.01), along with age (p < 0.01) and in-hospital complications (p < 0.001). Complication rates were similar between the two groups. Patients in the ERP had significantly fewer ER visits (p = 0.02), but there were no differences in readmission rates.


CONCLUSIONS
In patients undergoing scheduled laparoscopic colectomy in a university-based clinical teaching unit, ERP can further reduce length of stay and postoperative ER visits without increasing readmission rates.
Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
Nicoleta O
NO
Kolozsvari
Giovanni
G
Capretti
Pepa
P
Kaneva
Amy
A
Neville
Franco
F
Carli
Sender
S
Liberman
Patrick
P
Charlebois
Barry
B
Stein
Melina C
MC
Vassiliou
Gerald M
GM
Fried
Liane S
LS
Feldman
D003082:Colectomy / Q000534:rehabilitation*; D003108:Colonic Diseases / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000534:rehabilitation*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D016896:Treatment Outcome