Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines

Abstract

Objectives: This study aims to evaluate surgical outcomes (i.e. length of stay (LOS), 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the ERAS pathway, and determine its association with the rate of compliance to the different ERAS components. Methodology: This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then retrospectively compared to outcomes prior to the implementation of ERAS. Results: A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92% (SR:91.75%, CR:93.06%, RR:90.65%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.06 ± 6.67 vs 10.02 ± 5.43 days; p=0.002) and RR (19.85 ± 11.38 vs 16.85 ± 10.45 days; p=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar. Conclusion: Increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.

Lessons following implementation of a colorectal enhanced recovery after surgery (ERAS) protocol in a rural hospital setting

“…This trend has also been demonstrated in the NZ context, where patients undergoing elective colorectal surgery managed within an ERAS pathway had shorter hospital stays without increased morbidity or mortality 24 . However, post‐operative LOS at our institution was longer than contemporary LOS figures quoted by recent studies which range from 3 to 5 days 7,25–29 . This finding could reflect the rurality of our hospital; patients living up to 4 h away from the hospital, and our poor compliance in some of the ERAS protocol components.…”

“…24 However, post-operative LOS at our institution was longer than contemporary LOS figures quoted by recent studies which range from 3 to 5 days. 7,[25][26][27][28][29] This finding could reflect the rurality of our hospital; patients living up to 4 h away from the hospital, and our poor compliance in some of the ERAS protocol components.…”

Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer

“…Nevertheless, the length of postoperative hospital stay and early postoperative mortality rates did not differ between the two periods [35]. The enhanced recovery program, already adopted by many societies for colorectal cancer management, has been proven to be suitable even for fragile patients [41][42][43]. This could be one of the reasons why most studies did not show a difference in the length of hospital stay.…”

Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes

“…Recently, enhanced recovery after surgery (ERAS) program has shown that early rehab and early feeding in postoperative patients are good prognostic factors for patients' recovery [ 110 111 112 113 114 115 ]. The ERAS program recommends catheter removal on postoperative day 1, but surgeons should be taken care when removing it due to the risk of nerve damage during rectal cancer surgery.…”