Abstract
BackgroundEnhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified.MethodsWe evaluated 122 consecutive resections for obstructive colorectal cancer performed between July 2008 and November 2012 at Tokyo Metropolitan Bokutoh Hospital. Patients with rupture or impending rupture and those who received simple colostomy were excluded. The first set of 42 patients was treated based on traditional protocols, and the latter 80 according to modified ERAS protocols. The main endpoints were length of postoperative hospital stay, postoperative short-term morbidity, rate of readmission within 30 days, and mortality. Differences in modified ERAS protocols relative to traditional care include intensive preoperative counseling (by both surgeons and anesthesiologists), perioperative fluid management (avoidance of sodium/fluid overload), shortening of postoperative fasting period and early provision of oral nutrition, intraoperative warm air body heating, enforced postoperative mobilization, stimulation of gut motility, early removal of urinary catheter, and a multidisciplinary team approach to care.ResultsMedian (interquartile range) postoperative hospital stay was 10 (10–14.25) days in the traditional group, and seven (7–8.75) days in the ERAS group, showing a 3-day reduction in hospital stay (p < 0.01). According to the Clavien-Dindo classification, overall incidences of grade 2 or higher postoperative complications for the traditional and ERAS groups were 15 and 10% (p = 0.48), and 30-day readmission rates were 0 and 1.3% (p = 1.00), respectively. As for mortality, one patient in the traditional group died and none in the ERAS group (p = 0.34).ConclusionModified ERAS protocols for obstructive colorectal cancer reduced hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible for patients with obstructive colorectal cancer.
Highlights
Enhanced recovery after surgery (ERAS) protocols are well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity
We previously demonstrated that ERAS protocols for elective colorectal surgery helped reduce the length of postoperative hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible and effective in Japan, with its unique medical culture and public health insurance system [8]
The present study demonstrated that modified ERAS protocols for obstructive colorectal cancer can successfully accelerate patient recovery without increasing postoperative morbidity or readmission rates, and importantly, without compromising patient safety
Summary
Enhanced recovery after surgery (ERAS) protocols are well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. The efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified. Shida et al BMC Surgery (2017) 17:18 known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity [5, 6]. We previously demonstrated that ERAS protocols for elective colorectal surgery helped reduce the length of postoperative hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible and effective in Japan, with its unique medical culture and public health insurance system [8]. Obstructive colorectal cancer patients cannot eat orally before surgery and must fast preoperatively—this is in direct contradiction with ERAS protocols, which require no preoperative fasting [4]. Many intra-operative and postoperative evidence-based ERAS elements, such as postoperative ‘no fasting,’ can be applied to emergent colectomy [10]
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