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

Abstract

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.

A prospective cohort study to evaluate continuous wound infusion with local analgesics within an enhanced recovery protocol after colorectal cancer surgery

“…Moreover, the opioid consumption in patients that did use opioids was relatively low, with a converted cumulative dose of 10 mg of intravenous morphine. In comparison, other cohorts that incorporated ERAS, but did not use CWI, reported postoperative opioid consumptions of approximately 15–35 mg of intravenous morphine [22–24]. The low opioid consumption observed in this study further confirms the opioid‐sparing effect of CWI that has been described in several earlier studies among patients after different types of abdominal surgery, including colorectal surgery [9–11, 25, 26].…”

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

“…With the introduction of enhanced recovery pathways (ERPs), there has been a focus on laparoscopic surgery and early mobilization of patients undergoing surgery for colorectal cancer; however, few studies have examined the effect of anesthetic technique. [ 7 ] In terms of the postoperative SIR, few components of ERP have been proven to reduce the postoperative SIR with the exception of minimally invasive surgery. [ 8 ]…”