Abstract
BackgroundMajor colorectal surgery usually requires a hospital stay of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated with delay in recovery. The present work assesses the short and medium term results achieved by an enhanced recovery program based on previously published protocols.MethodsThis prospective study, performed at 12 Spanish hospitals in 2008 and 2009, involved 300 patients. All patients underwent elective colorectal resection for cancer following an enhanced recovery program. The main elements of this program were: preoperative advice, no colon preparation, provision of carbohydrate-rich drinks one day prior and on the morning of surgery, goal directed fluid administration, body temperature control during surgery, avoiding drainages and nasogastric tubes, early mobilisation, and the taking of oral fluids in the early postoperative period. Perioperative morbidity and mortality data were collected and the length of hospital stay and protocol compliance recorded.ResultsThe median age of the patients was 68 years. Fifty-two % of the patients were women. The distribution of patients by ASA class was: I 10%, II 50% and III 40%. Sixty-four % of interventions were laparoscopic; 15% required conversion to laparotomy. The majority of patients underwent sigmoidectomy or right hemicolectomy. The overall compliance to protocol was approximately 65%, but varied widely in its different components. The median length of postoperative hospital stay was 6 days. Some 3% of patients were readmitted to hospital after discharge; some 7% required repeat surgery during their initial hospitalisation or after readmission. The most common complications were surgical (24%), followed by septic (11%) or other medical complications (10%). Three patients (1%) died during follow-up. Some 31% of patients suffered symptoms that delayed their discharge, the most common being vomiting or nausea (12%), dyspnoea (7%) and fever (5%).ConclusionThe following of this enhanced recovery program posed no risk to patients in terms of morbidity, mortality and shortened the length of their hospital stay. Overall compliance to protocol was 65%. The following of this program was of benefit to patients and reduces costs by shortening the length of hospital stay. The implantation of such programmes is therefore highly recommended.
Highlights
Major colorectal surgery usually requires a hospital stay of more than 12 days
Inadequate pain management, intestinal dysfunction and immobilisation have been recognised since at least 1997 as among the main factors delaying postoperative recovery in patients subjected to major surgery [2]
Surgery and postoperative treatment Of all patients who initially met criteria for inclusion, 16 were excluded, 9 patients were in intensive care at the discretion of the anaesthetist and 7 received an unscheduled ileostomy
Summary
Major colorectal surgery usually requires a hospital stay of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated with delay in recovery. A stay of one week is usually the minimum that can be expected [1] This prolonged occupation of a hospital bed is not usually owed to problems of Inadequate pain management, intestinal dysfunction and immobilisation have been recognised since at least 1997 as among the main factors delaying postoperative recovery in patients subjected to major surgery [2]. This led Kehlet et al [3] to propose a series of measures designed to improve recovery following major colorectal surgery in their well-known multimodal recovery program. Some authors suggest this to be due to the organisational demands they make on surgeons, anaesthetists and nursing staff, and to social, cultural and economic realities [4]
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