title: Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational study.
abstract: OBJECTIVE
  Since the introduction and favourable early results of the enhanced recovery programme more than a decade ago, it has become increasingly popular following major abdominal surgery. The programme has now been adopted in the UK. The aim of our study was to see if the day of surgery affected hospital stay and we compared patients who had colorectal surgery early in the week (Monday to Wednesday) with those who had it later in the week (Thursday to Friday).
  
  
  METHODS
  Patient outcomes were studied between May 2010 and April 2011 from a prospectively maintained database. All colorectal surgeons involved in the enhanced recovery programme in our unit have a flexible rota and so no surgeon was operating on a particular day to avoid bias. An enhanced recovery programme protocol was utilised for all the patients with no bowel preparation, early feeding and early mobilisation.
  
  
  METHODS
  Study was carried out at the University Hospitals of Leicester.
  
  
  METHODS
  Patients undergoing elective colorectal resection between Monday and Friday.
  
  
  METHODS
  Hospital stay.
  
  
  RESULTS
  Two hundred and twenty-seven patients underwent surgery and were on the enhanced recovery programme during this period. Two (0.9%) patients who had surgery on a Sunday were excluded. Two hundred and twenty-five patients were analysed of which 155 (69%) were in the group (Monday to Wednesday) and 70 (31%) in the group (Thursday to Friday). No significant differences were observed amongst the groups for age (p = 0.129), sex (p = 0.555), tumour location (p = 0.140), operation performed (p = 0.127), type of surgery (laparoscopy or open, p = 0.892), complications (p = 0.428). However, a significant shorter length of stay was present in the first group six days (interquartile range: 4-10) versus eight days (interquartile range: 5-11) (p = 0.045).
  
  
  CONCLUSIONS
  Operating on colorectal patients early in the week is associated with a significant decreased hospital stay. This should be put into consideration by units practising enhanced recovery programme if the maximal benefit of this is to be attained.
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: Ugochukuwu
authors.initials: U
authors.lastname: Ihedioha
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: Faatimah
authors.initials: F
authors.lastname: Esmail
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lloyd
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Miller
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: Baljit
authors.initials: B
authors.lastname: Singh
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chaudhri
keywords: colorectal surgery; day of surgery; enhanced recovery