title: Enhanced recovery pathway for urgent colectomy.
abstract: BACKGROUND
  Enhanced recovery protocols have been proven to decrease complications and hospital stay following elective colorectal surgery. However, these principles have not yet been reported for urgent surgery procedures. We aimed to assess our initial experience with urgent colectomies performed within an established enhanced recovery pathway.
  
  
  METHODS
  In a prospective cohort study, all patients undergoing colonic resection between April 2012 and March 2013 were treated according to a standardized enhanced recovery protocol. Urgent surgeries were compared with the elective procedures with regards to baseline characteristics, compliance with enhanced recovery items, and clinical outcome.
  
  
  RESULTS
  Patients (N = 28) requiring urgent colonic resection were included and compared with patients undergoing elective colectomy (N = 63). Overall compliance with the protocol was 57% for the urgent compared with 77% for the elective procedures (p = 0.006). The pre-operative compliance was 64 versus 96% (p < 0.001), the intra-operative compliance was 77 versus 86% (p = 0.145), and the post-operative compliance was 49 versus 67% (p = 0.015), for the urgent and elective resections, respectively. Overall, 18 urgent patients (64%) and 32 elective patients (51%) developed postoperative complications (p = 0.261). Median postoperative length of stay was 8 days in the urgent setting compared with 5 days in the elective setting (p = 0.006).
  
  
  CONCLUSIONS
  Many of the intra-operative and post-operative enhanced recovery items can also be applied to urgent colectomy, entailing outcomes that approach the results achieved in the elective setting.
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland, didier.roulin@chuv.ch.
authors.forename: Didier
authors.initials: D
authors.lastname: Roulin
authors.forename: Catherine
authors.initials: C
authors.lastname: Blanc
authors.forename: Mirza
authors.initials: M
authors.lastname: Muradbegovic
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D003082:Colectomy / Q000009:adverse effects; D004434:Early Ambulation; D004435:Eating; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D000700:Analgesics