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Enhanced recovery implementation in colorectal surgery—temporary or persistent improvement?

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Abstract

Purpose

Enhanced recovery after surgery (ERAS) implementation has proven to reduce complication rate and length of hospital stay. Little is known about the sustainability of these results over time. The study aim was to assess the application of ERAS pathway over the first 4 years after initial implementation.

Methods

This retrospective study analyzed data collected prospectively from 482 consecutive elective colorectal patients operated in 2011 during the ERAS implementation process (n = 66), and after initial implementation in 2012 (n = 136), 2013 (n = 152), and 2014 (n = 128). Auditing ERAS was appraised from different perspectives: adherence with the ERAS protocol, clinical outcomes, and functional recovery. Patients were compared by year.

Results

The groups were similar in terms of demographics and surgical strategies. Length of stay remained stable at 7 days without significant variation over time (p = 0.741). The 30-day complications and readmission rates were not statistically different (respectively p = 0.068 and p = 0.639). There was also no difference in functional recovery, more particularly, first flatus occurred at day 2 (p = 0.177), pain was adequately controlled with oral analgesics at day 2 (p = 0.111), and patients were mobilized more than 4 h the first postoperative day in more than 60 % of cases (p = 0.343). Overall adherence with the ERAS pathway was 73 % during implementation and, respectively, 73 and 77 % for 2012 and 2013 after initial implementation (p = 0.614). A significant decrease between 2013 (77 %) and 2014 (73 %) was observed (p = 0.032).

Conclusions

Application of the institutional ERAS pathway could be maintained in the first 4 years after implementation leading to sustained improved functional recovery and clinical outcome.

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Authors’ contribution

Study conception and design: DM, MH, and ND

Acquisition of data: DM and VA

Analysis and interpretation of data: DM, DR, CB, ND, and MH

Drafting of manuscript: DM, DR, and MH

Critical revision of manuscript: DM, DR, VA, CB, ND, and MH

Author information

Authors and Affiliations

  1. Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland

    David Martin, Didier Roulin, Valérie Addor, Nicolas Demartines & Martin Hübner

  2. Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland

    Catherine Blanc

Authors
  1. David Martin
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  2. Didier Roulin
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  3. Valérie Addor
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  4. Catherine Blanc
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  5. Nicolas Demartines
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  6. Martin Hübner
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Corresponding author

Correspondence to Nicolas Demartines.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding

None.

Additional information

Presented to the 102th Annual Congress of the Swiss Society of Surgery, 2015, Bern, Switzerland; published in abstract form as Swiss Knife 2015; 12: special edition

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Martin, D., Roulin, D., Addor, V. et al. Enhanced recovery implementation in colorectal surgery—temporary or persistent improvement?. Langenbecks Arch Surg 401, 1163–1169 (2016). https://doi.org/10.1007/s00423-016-1518-9

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  • DOI: https://doi.org/10.1007/s00423-016-1518-9

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