Enhanced Recovery after Colorectal Surgery: Can We Afford Not to Use It?

Jung, Andrew; Dhar, Vikrom K.; Hoehn, Richard S.; Atkinson, Sarah; Johnson, Bobby L.; Rice, Teresa C.; Snyder, Jonathan R.; Rafferty, Janice F.; Edwards, Michael J.; Paquette, Ian M.

doi:10.1016/j.jamcollsurg.2017.12.031

Cited by 22 publications

(12 citation statements)

References 25 publications

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“…Consistent with our data, King et al found that ERP among CRC patients had a positive impact on postoperative outcomes, with slightly decreased, though not statistically significant, costs [17] . These cost analyses support our group's recent publication reporting that among a heterogenous colorectal patient population, ERP was associated with reduced costs [9] .…”

Section: Discussionsupporting

confidence: 84%

“…These efforts promoted buy in and facilitated universal implementation for colorectal surgery patients without a transition period. The details of our ERP have been previously reported [9] and are consistent with guidelines established by American Society of Colon and Rectal Surgeons [3] . In brief, patients were given oral gabapentin pre- and postoperatively.…”

Section: Methodssupporting

confidence: 54%

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Enhanced recovery protocol improves postoperative outcomes and minimizes narcotic use following resection for colon and rectal cancer

Cortez

Kassam

Levinsky

et al. 2019

Surgery Open Science

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Background Enhanced recovery protocols are associated with improved recovery. However, data on outcomes following the implementation of an enhanced recovery protocol in colorectal cancer are limited. We set out to study the postoperative outcomes, opioid use patterns, and cost impact for patients undergoing colon or rectal resection for cancer. Methods A retrospective review of all elective colorectal cancer resections from January 2015 to June 2018 at a single institution was performed. Patient demographics, operative details, and postoperative outcomes were collected. Colon and rectal patients were studied separately, with comparison of patients before and after the implementation of an enhanced recovery protocol. Results One hundred ninety-two patients underwent elective colorectal resection for cancer. In January 2016, an enhanced recovery protocol was implemented for all elective resections – 71 patients (33 colon and 38 rectal) underwent surgery before implementation and 121 patients (56 colon and 65 rectal) underwent surgery after implementation of the enhanced recovery protocol. There were no differences with regard to age, gender, or body mass index before or after implementation (all P > .05). For both colon and rectal cancer patients, the enhanced recovery protocol reduced time to regular diet (both P < .05) and length of stay (colon: 3 vs 4 days; rectal: 4 vs 6 days; both P < .01). Enhanced recovery protocol patients also consumed fewer total narcotics (colon: 44 vs 184 morphine milligram equivalents, P < .01; rectal: 121 vs 393 morphine milligram equivalents, P < .01). Conclusions Enhanced recovery protocol use reduced length of stay and narcotic use with similar total costs and no difference in 30-day complications for both colon and rectal cancer resections.

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Section: Discussionsupporting

confidence: 84%

Section: Methodssupporting

confidence: 54%

Enhanced recovery protocol improves postoperative outcomes and minimizes narcotic use following resection for colon and rectal cancer

Cortez

Kassam

Levinsky

et al. 2019

Surgery Open Science

Self Cite

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“…ERAS protocols are largely improving the experience of patients undergoing colorectal surgery but they also represent a huge step forward in team working, hospital dynamics and trust finances, as they reduce LOS, total hospital costs and pharmacy costs, with a contemporary reduction of complications and readmission rates [115] . In a world where new scientific evidences are published on daily basis it is normal that ERAS principles are still quite fluid, but this is not necessarily a bad thing.…”

Section: Resultsmentioning

confidence: 99%

Enhanced recovery after rectal surgery: what we have learned so far

Tebala¹,

Gordon–Dixon²,

Imtiaz³

et al. 2018

MIS

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Enhanced recovery after surgery (ERAS) protocols are gradually becoming the gold standard in the perioperative management of rectal patients. It is a multimodal and multidisciplinary approach that has the great merit to involve and empower the patient and bring him or her back to the centre of the strategy of care. If applied correctly, ERAS can improve the postoperative recovery, reduce the rate of complications and reduce the postoperative length of stay, in patients who had extensive pelvic dissection. The factors within ERAS and their application do not represent rigid schematizations but fluid concepts that may undergo substantial changes as soon as new evidence becomes available. The ERAS principles must be adapted to the specific environment and each team is expected to set up their own programme and quality control criteria. In this comprehensive review, the latest evidence and trend on enhanced recovery after rectal surgery have been critically appraised and presented.

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“…During our study, the average cost of acetaminophen per patient through 72 hours of admission was calculated as $182.00 per patient in our IV group compared with $35.00 per patient in our PO group, a cost that was not meaningfully compensated by the increased use of opioids in the PO group (cost of opioids through 72 hours: $5.50 per patient in IV group vs. $7.33 per patient in PO group). Although the difference in cost may at first appear substantial, it is unlikely to be significant when taken into account for the typical $9,000 to $20,000 expected costs of hospitalization within a typical admission following colorectal surgery (32). Additionally, we did not consider the possible cost savings experienced in our IV group secondary to the decreased incidence of nausea and vomiting, such as decreased need for perioperative antiemetic use.…”

Section: Discussionmentioning

confidence: 99%

Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery

Marcotte

2020

Pain Phys

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Background: Multimodal pain management within enhanced recovery after surgery (ERAS) protocols is designed to decrease opioid use, promote mobilization, and decrease postoperative complications. Objectives: To evaluate the role of intravenous (IV) versus oral (PO) acetaminophen within an established ERAS protocol in colorectal surgery. Study Design: This was a retrospective observational study. Setting: This research took place within an established perioperative colorectal surgery protocol. Methods: A total of 91 consecutive elective colorectal resections performed according to an ERAS protocol using only IV acetaminophen (IV group) were compared with 84 consecutive resections performed using one dose of IV acetaminophen followed by subsequent administration of oral acetaminophen (PO group). Our multimodal pain management strategy also included transverse abdominis plane blocks, celecoxib, and ketorolac medications for both groups. Opioid requirements, maximum and average daily pain scores by the Visual Analog Scale, and postoperative outcomes were compared between groups. Results: There were no differences in maximum or average pain scores on postoperative days 0-3 or at time of discharge between IV and PO groups. Compared with the IV acetaminophen only group, the PO group received significantly more perioperative opioids through 72 hours postoperatively (68.8 oral morphine equivalents [OME] IV group vs. 93.7 OME PO group; P < 0.0001), were more likely to require opioid patient-controlled analgesia (8.9% IV group vs. 46.4% PO group; P < 0.0001), and were more likely to experience postoperative nausea and vomiting (33.0% IV group vs. 48.8% PO group; P = 0.0449). Limitations: Significant limitations include the studies’ retrospective nature and that it was performed at a single institution. Conclusions: Restriction of IV acetaminophen within an ERAS protocol in colorectal surgery was associated with increased opioid use, greater need for opioid patient-controlled analgesia, and increased incidence of postoperative nausea and vomiting. IV acetaminophen may be superior to oral acetaminophen in the early postoperative setting. Key words: Perioperative pain management, enhanced recovery after surgery, acetaminophen, multimodal pain control, nonopioid

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Enhanced Recovery after Colorectal Surgery: Can We Afford Not to Use It?

Cited by 22 publications

References 25 publications

Enhanced recovery protocol improves postoperative outcomes and minimizes narcotic use following resection for colon and rectal cancer

Enhanced recovery protocol improves postoperative outcomes and minimizes narcotic use following resection for colon and rectal cancer

Enhanced recovery after rectal surgery: what we have learned so far

Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery

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