title: Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery.
abstract: BACKGROUND
  Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational interventions are effective. The aim of this prospective study was to investigate whether an enhanced recovery after surgery (ERAS) programme with dedicated ERAS and stoma nurse specialists focusing on counselling and stoma education can reduce the length of hospital stay, re-admission, and stoma-related complications and improve health-related quality of life (HRQoL) compared to current stoma education in a traditional standard care pathway.
  
  
  METHODS
  In a single-center study 122 adult patients eligible for laparoscopic or open colorectal resection who received a planned stoma were treated in either the ERAS program with extended stoma education (n = 61) or standard care with current stoma education (n = 61). The primary endpoint was total postoperative hospital stay. Secondary endpoints were postoperative hospital stay, major or minor morbidity, early stoma-related complications, health-related quality of life, re-admission rate, and mortality. HRQoL was measured by the generic 15D instrument.
  
  
  RESULTS
  Total hospital stay was significantly shorter in the ERAS group with education than the standard care group (median [range], 6 days [2-21 days] vs. 9 days [5-45 days]; p < 0.001). Regarding overall major and minor morbidity, re-admission rate, HRQoL, stoma-related complications and 30-day mortality, the two treatment groups exhibited similar outcomes.
  
  
  CONCLUSIONS
  Patients receiving a planned stoma can be included in an ERAS program. Pre-operative and postoperative stoma education in an enhanced recovery programme is associated with a significantly shorter hospital stay without any difference in re-admission rate or early stoma-related complications.
authors: Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway. Electronic address: havard.forsmo@helse-bergen.no.
authors: H M
authors: HM
authors: Forsmo
authors: Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway.
authors: F
authors: F
authors: Pfeffer
authors: Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
authors: A
authors: A
authors: Rasdal
authors: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors: H
authors: H
authors: Sintonen
authors: Department of Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors: H
authors: H
authors: Körner
authors: Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
authors: C
authors: C
authors: Erichsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D003125:Colostomy / Q000009:adverse effects*; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D054047:Surgical Stomas / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colorectal surgery; Complications; ERAS; Education; Stoma