title: The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway.
abstract: BACKGROUND
  Laparoscopic surgery is well established in the modern management of colorectal disease. More recently, enhanced recovery after surgery (ERAS) protocols have been introduced to further promote accelerated discharge and faster recovery. However, not all patients are suitable for early discharge. The purpose of this study was to evaluate the early outcomes of patients undergoing such a regime to determine which peri-operative factors may predict safe accelerated discharge.
  
  
  METHODS
  Data were prospectively collected on consecutive patients undergoing laparoscopic colorectal surgery. All patients followed the institution's ERAS protocol and were discharged once specific criteria were fulfilled. Clinical characteristics and outcomes were compared between patients who were discharged before and after 72 h post-surgery. Thereafter, the peri-operative factors that were associated with delayed discharge were determined using a binary logistic model.
  
  
  RESULTS
  Three hundred patients were included in the analysis. The most common operation was laparoscopic anterior resection (n = 123, 41%). Mean length of stay was 4.8 days (standard deviation 5.9), with 185 (62%) patients discharged within 72 h. Ten (3%) patients had a post-operative complication. Three independent predictors of delayed discharge were identified; BMI (OR 1.06, 95%CI 1.01-1.11), operation length (OR 0.99, 95%CI 0.98-0.99) and complications (OR 16.26, 95%CI 4.88-54.08).
  
  
  CONCLUSIONS
  A combined approach of laparoscopic surgery and ERAS leads to reduced length of stay. This enables more than 60% of patients to be discharged within 72 h. Increased BMI, duration of operation and complications post-operatively independently predict a longer length of stay.
authors.affiliation: Dept of GI Surgery, University College London Hospital, Euston Road, London, UK; Royal Marsden Hospital, Fulham Road, London, UK. Electronic address: Manish.chand@uclh.nhs.uk.
authors.forename: Manish
authors.initials: M
authors.lastname: Chand
authors.affiliation: Department of Surgery, Poole General Hospital, Longfleet Road, Poole, UK.
authors.forename: Henry D
authors.initials: HD
authors.lastname: De'Ath
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, UK.
authors.forename: Shahnawaz
authors.initials: S
authors.lastname: Rasheed
authors.affiliation: Department of Surgery, Poole General Hospital, Longfleet Road, Poole, UK.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Mehta
authors.affiliation: Department of Surgery, Poole General Hospital, Longfleet Road, Poole, UK.
authors.forename: James
authors.initials: J
authors.lastname: Bromilow
authors.affiliation: Department of Surgery, Poole General Hospital, Longfleet Road, Poole, UK.
authors.forename: Tahseen
authors.initials: T
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003108:Colonic Diseases / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010351:Patient Discharge / Q000706:statistics & numerical data; D059035:Perioperative Period; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*
keywords: Colonic disease/surgery; Discharge; Length of stay; Outcomes