title: Prospective study of colorectal enhanced recovery after surgery in a community hospital.
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) colorectal programs have shown to be successful at reducing length of stay in many international and academic centers; however, their efficacy in a community hospital setting remains unclear.
  
  
  OBJECTIVE
  To determine if favorable results could be reproduced in a community hospital setting using our ERAS program, which was developed using core ERAS guidelines with the goal of accelerated recovery while also addressing other important outcomes affecting patient experience and safety.
  
  
  METHODS
  Prospective study of ERAS program, a multidisciplinary effort involving anesthesia, preadmission staff, nursing, and surgery staff at a community hospital. The program was initiated in 2010 and was in full practice by 2011. We assessed practice patterns and patient outcomes for all elective colon and rectal resection cases performed in 2009 (prior to ERAS implementation), 2011, and 2012.
  
  
  METHODS
  Laparoscopic approach, narcotic use, length of stay, 30-day readmission, ileus (defined as reinsertion of nasogastric tube), and intra-abdominal infection and association between colorectal cancer (CRC) diagnosis and these outcomes.
  
  
  RESULTS
  From 2009 to 2012, the use of laparoscopy increased from 57.4% to 88.8% (P < .001). Length of stay decreased significantly (6.7 days vs 3.7 days, P < .001), without an increase in 30-day readmission rate (17.6% vs 12.5%, P = .49). Use of patient-controlled narcotic analgesia and duration of use decreased (63.2% of patients vs 15%, P < .001; 67.8 hours vs 47.1 hours, P = .02). Ileus rate decreased from 13.2% to 2.5% (P = .02). Intra-abdominal infection decreased from 7.4% to 2.5% (P = .24). When comparing laparoscopic cases alone, similar results were observed. Following regression analysis, there were no statistically significant differences between CRC diagnosis and LOS, 30-day readmission rates, ileus, and intra-abdominal infection (all P's > .05). Length of stay reductions resulted in an estimated cost savings of $3202 per patient (2011) and $4803 per patient (2012).
  
  
  CONCLUSIONS
  Implementation of this patient care-directed enhanced recovery program is feasible in a community hospital setting, and it is associated with decreased LOS without increased readmission or morbidity, as well as significant decreases in narcotic use and cost. Improved outcomes are independent of the laparoscopic approach and CRC diagnosis.
authors: Oregon Health and Science University, Department of Surgery, Portland.
authors: Cristina B
authors: CB
authors: Geltzeiler
authors: Legacy Good Samaritan Medical Center, Portland. Oregon.
authors: Alizah
authors: A
authors: Rotramel
authors: Legacy Good Samaritan Medical Center, Portland. Oregon.
authors: Charlyn
authors: C
authors: Wilson
authors: Devers Eye Institute, Legacy Health, Portland. Oregon.
authors: Lisha
authors: L
authors: Deng
authors: The Oregon Clinic, Portland.
authors: Mark H
authors: MH
authors: Whiteford
authors: Legacy Good Samaritan Medical Center, Portland. Oregon.
authors: Joseph
authors: J
authors: Frankhouse
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003082:Colectomy / Q000534:rehabilitation; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000534:rehabilitation*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy / Q000534:rehabilitation; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods / Q000534:rehabilitation*; D011446:Prospective Studies