Nicoleta O Kolozsvari, MD, Giovanni Capretti, MD, Pepa Kaneva, MSc, Amy Neville, MD, Franco Carli, MD, A. Sender Liberman, MD, Patrick Charlebois, MD, Barry Stein, MD, Melina C Vassiliou, MD, Gerald M Fried, MD, Liane S Feldman, MD. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Qc, Canada
Introduction:
Enhanced recovery programs (ERP) in colon surgery can reduce complications and length of stay. A laparoscopic approach also improves postoperative short-term outcomes for elective colectomy. Our study investigated whether ERP further improved the short-term outcomes of scheduled laparoscopic colon resection.
Methods:
We performed a medical record audit of all patients undergoing scheduled laparoscopic colon resection between January 2003 and August 2010 on a clinical teaching unit in a University-based institution. An ERP including accelerated introduction of oral nutrition, mobilization, pain control, and catheter management was introduced in 2005 with patients enrolled in the program at the surgeon’s discretion. The target length of stay (LOS) was 3 days. Demographic data, intra and postoperative details and 30-day ER visit and readmission rate were collected. We compared LOS and short-term outcomes for patients on the program with those receiving traditional postoperative care using Chi-square and regression models. Data are presented as median [25th, 75th percentile]. Statistical significance was defined as p<0.05.
Results:
136 (46%) of 297 eligible patients were enrolled in the enhanced ERP. At baseline, the two groups were similar in terms of age, gender distribution, BMI, ASA and diagnosis, but patients in the program were more likely to have their operation by a colorectal surgeon (96% vs. 88%, p=0.01).We excluded year from our regression models as there was high co-linearity between ERP enrolment and the year of the surgical procedure. Patients in the ERP ate solids earlier (POD 1[1,2] vs. 3[2,3.5], p<0.001) and had earlier removal of their urinary catheter (POD1[1,1] vs. 2[1,2], p<0.001). LOS was 4[3,6] days for both groups (p=0.004),with more patients in the ERP discharged by POD 3 (47 % vs. 26%, p=0.0006). After adjusting for other variables, ERP enrolment remained an independent predictor of LOS (p=0.007), along with age (p=0.003) and in-hospital complications (p<0.001).Complication rates were similar between the two groups (37% vs. 39%, p=0.18). Specifically, there was no increase in postoperative nausea and vomiting (18% vs. 17%, p=0.72) or the need for nasogastric tube (10% vs. 7%, p=0.28) despite rapid diet advancement in the ERP. There was also no difference in urinary retention (4% vs. 2%, p=0.34) notwithstanding earlier catheter removal. Patientsin the ERP had significantly fewer ER visits (2.9 vs. 9.3%, p=0.02) but there were no differences in readmission rates (8% vs. 7%, p=0.73). Among patients without complications, LOS was shorter if they were enrolled in the ERP (3[3,4] vs. 4[3,4] days, p<0.001).
Conclusion:
In patients undergoing scheduled laparoscopic colonic resection in a university-based clinical teaching unit, an enhanced recovery program can further reduce length of stay and postoperative ER visits without increasing readmission rates.
Session Number: ResFel – Residents/Fellows Scientific Session
Program Number: S132
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