Enhanced recovery program versus traditional postoperative care for elective open colorectal cancer surgery

Abstract

Background Traditional colorectal surgeries usually require a relatively long hospital stay of ∼10 days. Inadequate pain control, intestinal dysfunction, and immobilization are the main factors associated with delay in recovery. Enhanced recovery protocols have been used to optimize the perioperative care. Objectives To study the outcome of the enhanced recovery program for selected patients with colorectal malignancies subjected to elective surgery compared with similar patients subjected to surgery with traditional perioperative care. Patients and methods This prospective study was performed at Fayoum University Hospital from April 2008 to June 2017 and involved 97 patients who had uncomplicated colorectal cancer and were planned for elective open colorectal surgeries. They were divided into two groups: group A (44 patients) was subjected to surgery based on fast-track protocol and group B (53 patients) was subjected to surgery based on traditional perioperative care. Hospital stay, perioperative morbidity, mortality data, postoperative pain, and patient satisfaction data were collected, statistically analyzed, and recorded. Results In groups A and B, respectively, the mean±SD age was 47.3±5.1 and 43.7±6.1 years, the number of males was 31 and 44, whereas the number of females was 13 and nine. According to American Society of Anesthesiologists (ASA) score, 43.2 and 54.7% of patients were ASA I and 56.8 and 45.3% were ASA II in groups A and B, respectively. Overall, 40.9 and 43.4% underwent low anterior resection, 36.4 and 22.6% sigmoidectomy, 22.7 and 28.3% right colectomy, and 0 and 5.7% left colectomy in groups A and B, respectively. The mean±SD length of postoperative hospital stay was 3.58±0.24 and 8.84±1.87 days in groups A and B, respectively. There was no mortality in the two groups, and overall morbidity rate was 22.7 and 22.6% in groups A and B, respectively. Overall, 4.5 and 7.5% had wound infection, 2.3 and 0% had abdominal wall dehiscence, 11.4 and 11.3% had persistent vomiting, 2.3 and 3.8% had postoperative fever in groups A and B, respectively. Moreover, one (2.3%) patient in group A required readmission and resurgery to manage anastomotic leakage and peritonitis. Conclusions Enhanced recovery program for elective colorectal cancer surgery has a very good effect on postoperative recovery, as it shortens the length of hospital stay, with high safety and good patient compliance; therefore, we strongly recommend the application of such protocols, provided the availability of well-trained and adequately experienced personnel in well-equipped centers.