Enhanced Recovery After Surgery Versus Conventional Perioperative Care in Rectal Surgery

Teeuwen, P. H. E.; Bleichrodt, Robert P.; Jong, Paul J. M. de; Goor, Harry van; Bremers, André J. A.

doi:10.1007/dcr.0b013e318216067d

Cited by 35 publications

(16 citation statements)

References 26 publications

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“…rectal cancer surgery is known to be associated with higher complication rates and longer hospital stay than is colon resection. However, a reduction in the length of stay was found in patients who underwent laparoscopic rectal resection in this study when compared with 8-10 days in other studies (26,27), although shorter hospitalization time has also been reported (28). our results are in keeping with Delaney et al (29), who reported a reduced length of stay among patients who underwent complex pelvic and abdominal procedures such as total proctocolectomies and abdominoperineal resections in the fast-track setting.…”

Section: Determinants Affecting Postoperative Hospital Staysupporting

confidence: 88%

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

et al. 2014

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Results: there were no deaths. time to functional recovery was median 2 (interquartile range 2-3) days. the overall 30-day postoperative morbidity was 14.5% after bowel resection and 0% after sacrocolporectopexy. relaparotomy rate was 3.6% and 30-day readmission rate 7.2%. Postoperative hospital stay was median 3 days after small bowel and ileo-colic resection, 4 days after segmental colectomy, and 6 days after rectal resection and subtotal colectomy. Patient's body mass index > 30 kg/m 2 , malignant disease, complexity of surgery, recovery of bowel function later than 2 days after surgery, time to functional recovery > 2 days and postoperative morbidity were patient-and treatment-related determinants increasing postoperative hospital stay. Protocol compliance-related determinants increasing postoperative hospital stay were intake of normal food and mobilization ≥ 6 h/ day later than 2 days after surgery and removal of urinary catheter later than 1 day after surgery.

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Section: Determinants Affecting Postoperative Hospital Staysupporting

confidence: 88%

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

et al. 2014

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“…Teeuwan et al [31], in a study focused on rectal surgery patients, noticed a trend towards an increased readmission rate in the ERAS group, although the difference was not significant. This raises the question if early discharge is likely to raise readmission rates.…”

Section: Discussionmentioning

confidence: 95%

“…Recently, two cohort studies comparing ERAS and conventional perioperative care reported similar results: Teeuwen et al [31] studied results in open rectal surgery, and Huibers et al [32] in laparoscopic total mesorectal excision for rectal cancer. Both studies showed significantly shorter LOSH in the ERAS group [(median: 8 days vs. 12 days, p<0.005) and (median: 7 days vs. 10 days, p<0.001), respectively], with no significant difference in mortality, morbidity, and readmission rates between groups.…”

Section: Rectal Surgerymentioning

confidence: 86%

“…Functional recovery was also faster in the ERAS groups, with reduced time to first bowel movement (p<0,001, for both studies). Teeuwen et al [31] noted a trend towards more readmissions in the ERAS group, however this difference was not significant (17.1% vs. 7.3%; p<0.203). While these studies demonstrated a benefit in terms of LOSH in the ERAS group, caution must be exercised in interpreting these results due to their lack of randomization, which gives room for potential bias and confounding.…”

Section: Rectal Surgerymentioning

confidence: 88%

“…An adequate use of proper discharge criteria should prevent increased readmission rates in fast-track surgery. Other than this, several RCTs [16,31,49] studying the impact of the ERAS protocols did not include the discharge criteria in the publication. It is important for the discharge decision to be made according to standardized criteria and by clinicians who are not involved in the study, to secure that this decision is solemnly based on the patients' condition, and not influenced by the fact that the patient was randomized to the ERAS program.…”

Section: Discussionmentioning

confidence: 99%

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Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Tintim¹,

Machado²

2017

J Anesth Clin Res

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Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement

Day

Fielder

Calhoun

et al. 2015

British Journal of Surgery

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BACKGROUND Enhanced recovery (ER) protocols are widely used in surgical practice. As protocols are multidisciplinary with multiple components, it is difficult to compare and contrast reports. The present study therefore examined compliance and transferability to clinical practice among ER publications related to colorectal surgery. METHODS PubMed, EMBASE and Cochrane databases were searched for current colorectal ER manuscripts. Each publication was assessed for the number of ER elements, whether the element was sufficiently explained so that it could be transferred to clinical practice, and the compliance with the ER element. RESULTS Some 50 publications met the reporting criteria for inclusion. There were 22 ERAS elements described altogether. The median number of elements included in each publication was 9 with median number of included patients of 130. The most frequent elements included in ER pathways were early postoperative diet advancement in 49 (98%) and early mobilisation in 47 (94%). Early diet advancement was sufficiently explained in 43 (86%) publications but just 22 (45%) reported compliance. The explanation for early mobilisation was satisfactory in 41 (82%) publications but only 14 (30%) reported compliance. Other ERAS elements had similar rates of explanation and compliance. The most frequently analysed outcome measures were morbidity 49 (98%), length of stay 47 (94%), and mortality in 45 (90%) of publications. CONCLUSIONS The current standard of reporting is frequently incomplete. In order to transfer knowledge and facilitate implementation of pathways that demonstrate improvements in perioperative care and recovery, a consistent structured reporting platform is needed.

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Enhanced Recovery After Surgery Versus Conventional Perioperative Care in Rectal Surgery

Abstract: Enhanced recovery after surgery programs help to reduce the length of hospital stay after rectal surgery.

Cited by 35 publications

References 26 publications

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

Evaluation of a fast-track protocol for patients undergoing colorectal surgery

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement

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