Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery

Journal of the American College of Surgeons
Robert H ThieleTraci L Hedrick

Abstract

Colorectal surgery is associated with considerable morbidity and prolonged length of stay (LOS). Recognizing the need for improvement, we implemented an enhanced recovery (ER) protocol for all patients undergoing elective colorectal surgery at an academic institution. A multidisciplinary team implemented an ER protocol based on: preoperative counseling with active patient participation, carbohydrate loading, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, immediate postoperative feeding, and ambulation. Discharge requirements remained identical throughout. A before and after study design was undertaken comparing patients before (August 2012 to February 2013) and after implementation of an ER protocol (August 2013 to February 2014). Risk stratification was performed using the NSQIP risk calculator to calculate the predicted LOS for each patient based on 23 variables. One hundred and nine consecutive patients underwent surgery within the ER protocol compared with 98 consecutive historical controls (conventional). The risk-adjusted predicted LOS was similar for each group at 5.1 and 5.2 days. Substantial reductions were seen in LOS, morphine equivalents, intravenous flu...Continue Reading

References

Nov 1, 1983·British Journal of Obstetrics and Gynaecology·J LumleyC Wood
Jun 16, 1994·The New England Journal of Medicine·M A HayesD Watson
Oct 27, 1994·The New England Journal of Medicine·J L Vincent, D J Bihari
May 1, 1997·British Journal of Anaesthesia·H Kehlet
Jan 1, 1997·International Journal of Colorectal Disease·M A MemonS G From
Sep 18, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Y Y ChiaS T Ho
Sep 2, 2005·Annals of Surgery·Shukri F KhuriUNKNOWN Participants in the VA National Surgical Quality Improvement Program
Oct 31, 2006·Pharmacoepidemiology and Drug Safety·Wim G GoettschRon M C Herings
Dec 5, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Alain C Van ElstraeteDan Benhamou
Mar 27, 2007·Journal of the American College of Surgeons·Tsafrir VanounouMark P Callery
Sep 8, 2007·Critical Care : the Official Journal of the Critical Care Forum·Marcel R LopesFrédéric Michard
Oct 11, 2008·The British Journal of Surgery·G BalzanoV Di Carlo
Dec 4, 2008·Langenbeck's Archives of Surgery·Marc ReismannBenno M Ure
Feb 3, 2009·Journal of the American College of Surgeons·Lauren P WallnerJohn T Wei
Jun 18, 2010·Critical Care : the Official Journal of the Critical Care Forum·Jan BenesMartin Stepan
Aug 13, 2010·Langenbeck's Archives of Surgery·Pierluigi di SebastianoF Francesco di Mola
Nov 9, 2010·Critical Care Medicine·Thibault LoupecOlivier Mimoz
Apr 15, 2011·BMC Surgery·José M RamírezUNKNOWN Spanish working group on fast track surgery
Jul 7, 2011·The Annals of Pharmacotherapy·Jeffrey F BarlettaAnthony J Senagore
Oct 4, 2011·Anesthesia and Analgesia·Julian A Hood, R Jonathan T Wilson
Nov 24, 2011·QJM : Monthly Journal of the Association of Physicians·D G Van ZylE Delport
Feb 22, 2012·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Marie N HannaPeter Pronovost
Dec 25, 2012·Journal of Clinical Monitoring and Computing·Davinder S RamsinghRichard L Applegate

❮ Previous
Next ❯

Citations

Apr 17, 2016·The Journal of Surgical Research·Julia K ShinnickMehul V Raval
Oct 22, 2015·Expert Review of Gastroenterology & Hepatology·Justin T BradyConor P Delaney
Oct 3, 2015·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Jeffrey M SuttonDaniel E Abbott
Dec 24, 2015·Surgical Endoscopy·Thomas D MartinRobert K Cleary
Mar 13, 2016·Journal of the American College of Surgeons·Olubode A OlufajoZara Cooper
Dec 24, 2015·Best Practice & Research. Clinical Obstetrics & Gynaecology·Marco Aurelio Pinho OliveiraRudy Leon De Wilde
Mar 24, 2016·The Annals of Thoracic Surgery·Kenan W Yount, Gorav Ailawadi
Apr 24, 2016·Journal of the American College of Surgeons·Florence E TurrentineRayford Scott Jones
Aug 20, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Karsten Bartels, Robert H Thiele
Apr 28, 2016·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Christina M PapageorgeEvie H Carchman
Jun 12, 2016·Surgical Endoscopy·Margaret A PlymaleJ Scott Roth
Jul 12, 2016·Neurologia Medico-chirurgica·Takao YasuharaIsao Date
Dec 23, 2016·Surgical Endoscopy·Deborah S KellerUNKNOWN SAGES SMART Task Force
Jan 24, 2017·Anesthesiology·Lauren K Dunn, Marcel E Durieux
Aug 9, 2016·Obstetrics and Gynecology·Susan C ModesittTraci L Hedrick
Dec 26, 2015·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Elles Steenhagen
Dec 1, 2017·International Anesthesiology Clinics·Nisha ChhabraSajid S Shahul
Dec 23, 2017·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Jessica A GeorgeChristopher L Wu
Apr 10, 2018·Current Opinion in Pediatrics·Mehul V Raval, Kurt F Heiss
Jun 9, 2018·Surgical Infections·Christopher A GuidryRobert G Sawyer
Jul 12, 2018·Diseases of the Colon and Rectum·Taryn E HassingerTraci L Hedrick
Aug 24, 2018·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Keith B AllenKevin F Kennedy
Sep 6, 2017·International Urogynecology Journal·Elisa R TrowbridgeKathie L Hullfish
Jan 10, 2019·Journal of Cardiac Surgery·Sameer A HirjiMarc P Pelletier
Dec 10, 2015·Regional Anesthesia and Pain Medicine·Abdullah S TerkawiMarcel E Durieux
Oct 31, 2018·International Urogynecology Journal·Elisa Rodriguez TrowbridgeKathie L Hullfish
Apr 5, 2019·Surgical Endoscopy·Karsten BartelsSusan K Mikulich-Gilbertson
May 2, 2019·Current Pain and Headache Reports·Amir ElhassanAlan David Kaye
Apr 2, 2019·Neurosurgical Focus·Mazin ElsarragM Yashar S Kalani
Aug 6, 2019·The Journal of International Medical Research·Ruyue GaoFei Guo
Oct 3, 2019·Surgical Endoscopy·Chris HarrymanJ Scott Roth

❮ Previous
Next ❯

Related Concepts

Related Feeds

Aminoglycosides

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.

Antifungals

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.

Antifungals (ASM)

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.

Aminoglycosides (ASM)

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.