Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial.
OBJECTIVE
The aim of this randomized clinical trial was to compare patients treated using a multimodal approach [enhanced recovery after surgery (ERAS)], with a special focus on counselling, to patients treated in a standard conventional care pathway, who underwent elective colorectal resection.


METHODS
In a single-centre trial, adult patients eligible for open or laparoscopic colorectal resection were randomized to an ERAS programme or standard care. The primary end-point was postoperative total hospital stay. Identical discharge criteria were defined for both treatment groups. Secondary end-points included postoperative complications, postoperative C-reactive protein levels, postoperative hospital stay, readmission rate and mortality. All parameters were recorded before operation, on the day of surgery and daily thereafter until discharge.


RESULTS
Total hospital stay was significantly shorter among patients randomized to ERAS than among the standard group [median 5 days (range 2-50 days) vs median 8 days (range 2-48 days); P = 0.001]. The two treatment groups exhibited similar outcomes regarding overall major and minor morbidity, reoperation rate, readmission rate and 30-day mortality. There were also no differences in tolerance of enteral nutrition or in the inflammatory response, as reflected by postoperative C-reactive protein levels.


CONCLUSIONS
ERAS care was associated with a significantly shorter length of hospital stay. Without any difference in surgical or general complications, tolerance of enteral nutrition or postoperative C-reactive protein levels, peri-operative information and guidance for ensuring that patients comply with the ERAS approach appear to be important factors to reduce the length of hospital stay.
Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
H M
HM
Forsmo
Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
F
F
Pfeffer
Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
A
A
Rasdal
Department of Anesthesiology, Haukeland University Hospital, Bergen, Norway.
G
G
Østgaard
Department of Gastrointestinal Surgery, Haugesund Hospital, Haugesund, Norway.
A C
AC
Mohn
Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
H
H
Körner
Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
C
C
Erichsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols / Q000592:standards*; D003082:Colectomy / Q000592:standards; D003108:Colonic Diseases / Q000601:surgery*; D003289:Convalescence; D003376:Counseling; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Colorectal surgery; ERAS; complication; counselling