Abstract
BackgroundTo identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards.MethodsConsecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days).ResultsAnalysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS.ConclusionsNon-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team’s expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.
Highlights
Colorectal surgery is associated with a long length of stay (LOS) [1], contributing significantly to the cost of healthcare [2]
We identified several factors that were associated with a suboptimal LOS
Among Enhanced Recovery After Surgery (ERAS) recommendations, only open approach and failure to remove indwelling catheters (IDC) on postoperative day 1 were independently associated with suboptimal LOS, which is similar to the findings of other studies investigating ERAS compliance [20]
Summary
Colorectal surgery is associated with a long length of stay (LOS) [1], contributing significantly to the cost of healthcare [2]. In order to address this, the Enhanced Recovery After Surgery (ERAS) Society developed 20 recommendations, aiming to reduce morbidity and LOS following elective colorectal surgery [3]. While overall adherence to an ERAS protocol results in improved postoperative outcomes, the importance of individual recommendations is less clear [7]. Lack of clear evidence supporting individual ERAS recommendation has led hospitals to tailor protocols to their own settings. To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommenda‐ tions is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards
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