title: Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry.
abstract: Previous studies reported that laparoscopic surgery (LPS) improved postoperative outcomes in patients undergoing colorectal surgery within an enhanced recovery program (ERP). However, the effect of minimally invasive surgery on each ERP item has not been clarified, yet. The aim of this study is to assess the impact of LPS on adherence to ERP items and recovery as measured by time to readiness for discharge (TRD).
  
  
  
  Prospectively collected data entered in an electronic Italian registry specifically designed for ERP were reviewed. Patients undergoing elective colorectal surgery were divided into three groups: successful laparoscopy, conversion to open surgery, primary open surgery. Adherence to 19 ERP elements and postoperative outcomes were compared among groups. Multivariate regression analysis was used to identify whether LPS had an independent role to improve ERP adherence and postoperative outcomes.
  
  
  
  714 patients (successful LPS 531, converted 42, open 141) underwent elective colorectal surgery within an ERP. Epidural analgesia was used in the 75.1% of open group patients versus 49.9% of LPS group patients (p = 0.012). After surgery, oral feeding recovery, i.v. fluids suspension, removal of both urinary and epidural catheters occurred earlier in the LPS group both in the overall series and in uneventful patients only. Mean TRD and length of hospital stay were significantly shorter in the LPS group (p < 0.001 for both). Overall morbidity rate was 18.7% in the LPS group versus 32.6% in the open group (p = 0.001). At multivariate analysis, LPS was significantly associated to an increased adherence to postoperative ERP items, a shorter TRD, and a reduced overall morbidity, whereas rectal surgery and new stoma formation impaired postoperative recovery.
  
  
  
  The present study showed that a successful laparoscopic procedure had an independent role to increase the adherence to postoperative ERP and to improve short-term postoperative outcome.
authors.affiliation: Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy. braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.affiliation: Department of Surgery, Cuneo Hospital, Cuneo, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Borghi
authors.affiliation: Department of Surgery, Prato Hospital, Prato, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scatizzi
authors.affiliation: Department of Surgery, Casa di Cura Città di Udine, Udine, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Missana
authors.affiliation: Department of Surgery, Cantù Hospital, Cantù, Italy.
authors.forename: Marco Azzola
authors.initials: MA
authors.lastname: Guicciardi
authors.affiliation: Department of Surgery, Humanitas Hospital IRCCS, Rozzano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bona
authors.affiliation: Department of Surgery, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Ficari
authors.affiliation: Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Maspero
authors.affiliation: Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pecorelli
mesh_terms: D000328:Adult; D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies
keywords: Colorectal surgery; Enhanced recovery pathway; Laparoscopy; Length of hospital stay; Postoperative complications; Time to readiness for discharge