Case-matched series of enhanced <i>versus</i> standard recovery pathway in minimally invasive colorectal surgery

Lovely, Jenna K.; Maxson, Pamela M.; Jacob, Adam K.; Cima, Robert R.; Horlocker, Terese T.; Hebl, James R.; Harmsen, William S.; Huebner, Marianne; Larson, David W.

doi:10.1002/bjs.7692

Cited by 110 publications

(73 citation statements)

References 31 publications

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“…Enhanced recovery challenges traditional perioperative paradigms and has been shown to hasten postoperative recovery in colorectal surgery. 7,8,12,13,24-26 Prior investigations of enhanced recovery have shown only preliminary evidence of benefit 18,19 and data are very limited for patients with gynecologic malignancies. 18,19 One investigation describes 19 cases over 8 years, 18 whereas the other included 69 patients who underwent cytoreduction with a median operating time of only 2 hours.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery in Gynecologic Surgery

Kalogera

Bakkum-Gamez

Jankowski

et al. 2013

Obstetrics &Amp; Gynecology

253

186

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OBJECTIVE To investigate the effects of enhanced recovery (a multimodal perioperative care enhancement protocol) in patients undergoing gynecologic surgery. METHODS Consecutive patients managed under an enhanced recovery pathway and undergoing cytoreduction, surgical staging, or pelvic organ prolapse surgery between June 20, 2011, and December 20, 2011, were compared with consecutive historical controls (March to December 2010) matched by procedure. Wilcoxon rank-sum, χ2, and Fisher's exact tests were used for comparisons. Direct medical costs incurred in the first 30 days were obtained from the Olmsted County Healthcare Expenditure and Utilization Database and standardized to 2011 Medicare dollars. RESULTS A total of 241 enhanced recovery women in the case group (81 cytoreduction, 84 staging, and 76 vaginal surgery) were compared with women in the control groups. In the cytoreductive group, patient-controlled anesthesia use decreased from 98.7% to 33.3% and overall opioid use decreased by 80% in the first 48 hours with no change in pain scores. Enhanced recovery resulted in a 4-day reduction in hospital stay with stable readmission rates (25.9% of women in the case group compared with 17.9% of women in the control group) and 30-day cost savings of more than $7,600 per patient (18.8% reduction). No differences were observed in rate (63% compared with 71.8%) or severity of postoperative complications (grade 3 or more: 21% compared with 20.5%). Similar, albeit less dramatic, improvements were observed in the other two cohorts. Ninety-five percent of patients rated satisfaction with perioperative care as excellent or very good. CONCLUSIONS Implementation of enhanced recovery was associated with acceptable pain management with reduced opioids, reduced length of stay with stable readmission and morbidity rates, good patient satisfaction, and substantial cost reductions.

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery in Gynecologic Surgery

Kalogera

Bakkum-Gamez

Jankowski

et al. 2013

Obstetrics &Amp; Gynecology

253

186

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“…Data were derived from a prospectively maintained institutional electronic enhanced recovery database. Items of the database have been described previously . This study was approved by the Institutional Review Board as part of the institutional enhanced recovery quality improvement project.…”

Section: Methodsmentioning

confidence: 99%

Comparison of recovery and outcome after left and right colectomy

et al. 2019

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Aim The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30‐day complications, were compared between left‐sided and right‐sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left‐sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion Despite equal ERP compliance, postoperative ileus was higher after right‐sided colectomies. This finding was associated with Crohn's disease and fluid overload.

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“…Surgery for colorectal cancer has improved as a result of minimally invasive procedures (MIS) and the implementation of enhanced recovery after surgery (ERAS) programmes. Their use has reduced perioperative morbidity and reduced length of hospital stay (LOS). The combination of ERAS principles and advances in MIS have inspired the concept of accelerated postoperative pathways for discharge.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial)

Bednarski

Nickerson

You

et al. 2019

British Journal of Surgery

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Background Minimally invasive surgery (MIS) and enhanced recovery protocols (ERPs) have improved postoperative recovery and shortened length of hospital stay (LOS). Telemedicine technology has potential to improve outcomes and patient experience further. This study was designed to determine whether the combination of MIS, ERP and a structured telemedicine programme (TeleRecovery) could shorten total 30‐day LOS by 50 per cent. Methods This was a phase II prospective RCT at a large academic medical centre. Eligible patients aged 18–80 years undergoing minimally invasive colorectal resection using an ERP were randomized after surgery. The experimental arm (RecoverMI) included accelerated discharge on postoperative day (POD) 1 with or without evidence of bowel function and a televideoconference on POD 2. The control arm was standard postoperative care. The primary endpoint was total 30‐day LOS (postoperative stay plus readmission/emergency department/observation days). Secondary endpoints included patient‐reported outcomes measured by EQ‐5D‐5L™, Brief Pain Inventory (BPI) and a satisfaction questionnaire. Results Thirty patients were randomized after robotic (21 patients) or laparoscopic (9) colectomy, including 14 patients in the RecoverMI arm. Median 30‐day total LOS was 28·3 (i.q.r. 23·7–43·6) h in the RecoverMI arm and 51·5 (43·8–67·0) h in the control arm (P = 0·041). There were no differences in severe adverse events or EQ‐5D‐5L™ score between the study arms. The BPI revealed low pain scores regardless of treatment arm. Satisfaction was high in both arms. Conclusion In patients having surgery for colorectal neoplasms, the trimodal combination of MIS, ERP and TeleRecovery can reduce 30‐day LOS while preserving patients' quality of life and satisfaction. Registration number: NCT02613728 ( https://clinicaltrials.gov).

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Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery

Abstract: ERP decreased the length of hospital stay after minimally invasive colorectal surgery.

Cited by 110 publications

References 31 publications

Enhanced Recovery in Gynecologic Surgery

Enhanced Recovery in Gynecologic Surgery

Comparison of recovery and outcome after left and right colectomy

Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial)

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