Multicenter Observational Study Examining the Implementation of Enhanced Recovery Within the Virginia Surgical Quality Collaborative in Patients Undergoing Elective Colectomy

Hedrick, Traci L.; Thiele, Robert H.; Hassinger, Taryn E.; Donovan, Jean; Reines, H. David; Damico, Edward F.; Fogel, Sandy; Jones, James E.; Posadas, Jorge; Jones, R. Scott; Turrentine, Florence E.

doi:10.1016/j.jamcollsurg.2019.04.033

Cited by 18 publications

(24 citation statements)

References 33 publications

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“…This mirrors the results from early fast-track protocols published for colonic resections through those of more modern ERAS protocols, demonstrating reductions of about 1 to 2 hospital days for all patient populations undergoing elective colorectal surgery. [3][4][5][6][7][8][9][10][11][12][13]15 There was also a signification reduction of organ space infections in the CD patients under the ERAS protocol, without differences in demographic and preoperative variables. While ERAS protocols have been associated with decreased overall postoperative morbidity, they have not been shown to decrease surgical complications such as organ space infections and anastomotic leaks.…”

Section: Discussionmentioning

confidence: 86%

“…1,2 Enhanced recovery after surgery (ERAS) protocols, now widely employed in both elective and nonelective colorectal surgery, have been successful in reducing such postoperative morbidities through minimizing surgical stress, accelerating return of bowel function, and reducing hospital length of stay (LOS). [3][4][5][6][7][8][9][10][11][12][13][14][15] Enhanced recovery after surgery protocols have been shown as the superior option for patients with colon cancer (CC) undergoing open or laparoscopic colectomies. 14,15 However, ERAS effects on the inflammatory bowel disease (IBD) population remain unclear, bringing to question whether the protocols are universally beneficial for colorectal patients' postoperative courses.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

Croasdale

Olutola

et al. 2020

The American Surgeon

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Background Enhanced recovery after surgery (ERAS) protocols are widely employed in colorectal surgery, successful in reducing postoperative morbidities and hospital length of stay (LOS). However, ERAS effects on the inflammatory bowel disease population remain unclear. This study examines the postoperative course of both Crohn’s disease (CD) and colon cancer (CC) patients after elective right hemicolectomies and compares the effectiveness of ERAS protocol. Methods A retrospective analysis was performed on patients with CD and CC undergoing elective right hemicolectomies and ileocecectomies from January 2014 through June 2016 (pre-ERAS) and January 2017 through April 2019 (post-ERAS) from a single tertiary care center. Patient demographics and perioperative variables were examined, including prolonged postoperative ileus (PPOI), hospital LOS, and 30-day readmission. Results 98 CC patients and 91 CD patients met the inclusion criteria. The pre-ERAS CC and post-ERAS CC cohorts were significantly different: post-ERAS had fewer patients with congestive heart failure and chronic obstructive pulmonary disease and had higher albumin levels. The pre-ERAS CC cohort had significantly longer operative durations and higher rates of concomitant procedures than the post-ERAS CC cohort. Both patients with CC and CD had a reduction in LOS with implementation of ERAS, decreasing by 2.24 days ( P = .002) and 1.21 days ( P = .038), respectively. There was a reduction in rates of organ space infections with CD (pre .132, post .00, P = .007). There was a trend towards an increased rate of PPOI with CD (Pre .079, Post .226, P = .062). Discussion The ERAS protocol significantly reduced LOS for both groups, without increasing 30-day readmission rates or other morbidities.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

Croasdale

Olutola

et al. 2020

The American Surgeon

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“… 53 Programs such as Enhanced Recovery After Surgery (ERAS) have decreased hospital length of stay, but patients still occupy a hospital bed for an average of 3 days following laparoscopic, and 4 days following open partial colectomies. 54 , 55 …”

Section: Surgical Considerations Based On Cancer and Patient Charactementioning

confidence: 99%

Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic

O’Leary¹,

Choong²,

Thornblade³

et al. 2020

Annals of Surgery

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Objective: The COVID-19 pandemic requires to conscientiously weigh “timely surgical intervention” for colorectal cancer against efforts to conserve hospital resources and protect patients and health care providers. Summary Background Data: Professional societies provided ad-hoc guidance at the outset of the COVID-19 pandemic on deferral of surgical and perioperative interventions, but these lack specific parameters to determine the optimal timing of surgery. Methods: Using the GRADE system, published evidence was analyzed to generate weighted statements for stage, site, acuity of presentation, and hospital setting to specify when surgery should be pursued, the time and duration of oncologically acceptable delays, and when to utilize nonsurgical modalities to bridge the waiting period. Results: Colorectal cancer surgeries—prioritized as emergency, urgent with imminent emergency or oncologically urgent, or elective—were matched against the phases of the pandemic. Surgery in COVID-19-positive patients must be avoided. Emergent and imminent emergent cases should mostly proceed unless resources are exhausted. Standard practices allow for postponement of elective cases and deferral to nonsurgical modalities of stage II/III rectal and metastatic colorectal cancer. Oncologically urgent cases may be delayed for 6(–12) weeks without jeopardizing oncological outcomes. Outside established principles, administration of nonsurgical modalities is not justified and increases the vulnerability of patients. Conclusions: The COVID-19 pandemic has stressed already limited health care resources and forced rationing, triage, and prioritization of care in general, specifically of surgical interventions. Established guidelines allow for modifications of optimal timing and type of surgery for colorectal cancer during an unrelated pandemic.

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“…These data support early discharge as clinically appropriate for patients identified by procedure-specific enhanced recovery pathways. 23,24…”

Section: Discussionmentioning

confidence: 99%

“…These data support early discharge as clinically appropriate for patients identified by procedure-specific enhanced recovery pathways. 23,24 The timing and occurrence of complications in relation to day of discharge is notable. Not surprisingly, patients who were hospitalized longer had greater proportions of morbidity while recovering from operation during the index hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

et al. 2020

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Objective: Our objective was to examine the associations between early discharge and readmission after major abdominal operations. Background: Advances in patient care resulted in earlier patient discharge after complex abdominal operations. Whether early discharge is associated with patient readmissions remains controversial. Methods: Patients who had colorectal, liver, and pancreas operations abstracted in 2011-2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were included. Patient readmission was stratified by 6 operative groups. Patients who were discharged before median discharge date within each operative group were categorized as an early discharge. Analyses tested associations between early discharge and likelihood of 30-day postoperative unplanned readmission. Results: A total of 364,609 patients with major abdominal operations were included. Individual patient groups and corresponding median day of discharge were: laparoscopic colectomy (n = 152,575; median = 4), open colectomy (n =137,462; median = 7), laparoscopic proctectomy (n = 12,238; median = 5), open proctectomy (n = 24,925; median = 6), major hepatectomy (n = 9,805; median = 6), pancreatoduodenectomy (n = 27,604; median = 8). Early discharge was not associated with an increase in proportion of readmissions in any operative group. Early discharge was associated with a decrease in average proportion of patient readmissions compared to patients discharged on median date in each of the operative groups: laparoscopic colectomy 6% versus 8%, open colectomy 11% versus 14%, laparoscopic proctectomy 13% versus 16%, open proctectomy 13% vs 17%, major hepatectomy 8% versus 12%, pancreatoduodenectomy 16% versus 20% (all P ≤ 0.02). Serious morbidity composite was significantly lower in patients who were discharged early than those who were not in each operative group (all P < 0.001). Conclusions: Early discharge in selected patients after major abdominal operations is associated with lower, and not higher, rate of 30-day unplanned readmission.

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Multicenter Observational Study Examining the Implementation of Enhanced Recovery Within the Virginia Surgical Quality Collaborative in Patients Undergoing Elective Colectomy

Cited by 18 publications

References 33 publications

The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn’s Disease vs. Colon Cancer: A Retrospective Cohort Analysis

Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

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