title: Early Discharge After Colorectal Resection: The Positive Impact of an Enhanced Recovery Program on a Rural Colorectal Surgery Service.
abstract: BACKGROUND
  Enhanced recovery (ER) programs are policies and protocols meant to improve postoperative recovery after surgery. As a consequence of a smoother recovery, patients can be discharged early. This paper describes the impact of an ER program in colorectal surgery in a rural hospital.
  
  
  METHODS
  In total, 132 patients had colorectal resection within the ER program. Data were collected prospectively. The ER pathway affects perioperative management in the following ways in order to: (1) improve patient's general condition before surgery, (2) minimize intraoperative surgical trauma by using a laparoscopic approach in all cases, and (3) facilitation of a quicker postoperative return of physiological function.
  
  
  RESULTS
  Most (86.4%) of the patients have been operated as elective cases and for a cancer (73.5%). Laparoscopic resection was performed in 63.6% of patients, with a conversion rate of 10.6%. Total morbidity was 18.2%, leak rate was 1.5%, and 90-day mortality rate was 3%. Overall median postoperative stay was 6.5 days. Total length of in-hospital stay was lower in laparoscopic resections (5.5 d), elective cases (6 d), and in younger patients (6 d). Age and laparoscopic access were independent prognostic factors significantly associated with early discharge in elective patients. Overall readmission rate was 9.1% and this was not affected by any preoperative or intraoperative factor within those in this study.
  
  
  CONCLUSIONS
  The ER program positively impacted the outcome of colorectal resections also in our rural setting. Discharging patients expeditiously did not affect postoperative morbidity or readmission rate.
authors: Gastrointestinal Surgery Unit-Colorectal Team, Noble's Hospital, Isle of Man, UK.
authors: Giovanni D
authors: GD
authors: Tebala
authors: Sean
authors: S
authors: Keane
authors: Abdelsalam
authors: A
authors: Osman
authors: Mina
authors: M
authors: Ip
authors: Abdul Q
authors: AQ
authors: Khan
authors: Luciano
authors: L
authors: Perrone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010351:Patient Discharge / Q000639:trends*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012424:Rural Population; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology