Abstract
BackgroundThe advantages of Enhanced Recovery (ER) programmes are well known, in terms of improved overall experience of the patients, which associates with low morbidity and reduced length of stay. As a result, the pattern of morbidity is changing and some patients may develop complications after discharge. Aim of this work was to evaluate the impact of morbidity and related outcomes such as unplanned readmission and reoperation rate on an ER programme in colorectal surgery.MethodsProspectively collected clinical data of patients who underwent colorectal resection have been retrospectively analysed. Endpoints were: 90-day mortality and morbidity, length of hospital stay (LOS) and rate of unplanned readmissions and reoperations.ResultsMortality and morbidity did not change in the analysed period, but LOS reduced significantly. Main determinant of postoperative LOS was the type of surgical approach, laparoscopy being associated with earlier discharge. LOS was longer in patients who developed complications. Morbidity and reoperation rate were significantly higher in patients discharged after day 4. Majority of complications happened in patients who were still in the hospital. However, the few patients who developed complications after discharge did not have a worse outcome if compared to those who had complications in hospital.ConclusionsER protocols must become integral part of the perioperative management of colorectal patients. ER and laparoscopy have a synergic effect to improve the postoperative recovery and reduce morbidity. Early discharge of patients does not affect the outcome of postoperative complications.
Highlights
The advantages of Enhanced Recovery (ER) programmes are well known, in terms of improved overall experience of the patients, which associates with low morbidity and reduced length of stay
Risk of leak for laparoscopic operations is reduced by 90% with respect to open operations
Our study confirmed that morbidity and length of hospital stay (LOS) are significantly reduced in laparoscopy within an ER protocol [27], due to reduced metabolic impairment and tissue damage [28], with respect to the traditional perioperative protocols
Summary
The advantages of Enhanced Recovery (ER) programmes are well known, in terms of improved overall experience of the patients, which associates with low morbidity and reduced length of stay. The concept of surgical Fast Track has been proposed in the 90s by Henrik Kehlet [1, 2] as a consequence of the increased demand for better efficacy and reduced invasiveness of surgery by patients and surgeons It entails applying the most recent scientific evidence to the perioperative management of surgical patients, in order to improve their postoperative recovery and, as a consequence, reduce their hospital stay [3,4,5]. The name initially chosen, “Fast Track”, recalled mostly an early (but probably unsafe) discharge of a surgical patient, without highlighting the real benefits For this reason many surgeons were – and in many cases still are – concerned of the possible medico-legal consequences in case of complications and many patients considered it only a way to reduce the costs of healthcare. ER protocols aim at optimising the postoperative recovery as they “reduce surgical stress, maintain postoperative physiological function, and enhance mobilisation after surgery” [6]
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