Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Abstract

Background and Objectives:Combining laparoscopy and enhanced recovery provides benefit to short-term outcomes after colorectal surgery. Advances in training and techniques have allowed surgeons to operate on cases that are technically challenging and associated with prolonged operative time. Laparoscopic techniques improve the outcome of enhanced recovery after colorectal surgery; however, there are no specifications on the effect of prolonged operations on the outcome. The objective was to elucidate the impact of prolonged surgery and blood loss on the outcome of enhanced recovery after surgery after laparoscopic colorectal surgery.Methods:Four-hundred patients who underwent elective colorectal resection on enhanced recovery after surgery in Yeovil District Hospital between 2002 and 2009 were retrospectively reviewed. Delayed discharge was defined as a prolonged length of stay beyond the mean in this series (≥8 days).Results:Three-hundred eighty-five patients were included. Median operative time was 180 minutes with a median blood loss of 100 mL. Conversion was not associated with a prolonged length of stay. Operative time and blood loss correlated with length of stay in a stepwise fashion. There were 2 cutoff points of operative time at 160 minutes and 300 minutes (5 hours), where risk of prolonged stay increased significantly (odds ratio [OR] = 2.02; 95% confidence interval [CI], 1.05–3.90; P = .027), and blood loss of >500 mL (OR = 3.114; 95% CI, 1.501–6.462, P = .002).Conclusions:Total operative timing impacts negatively on the outcome of enhanced recovery after laparoscopic colorectal resections with increased risk of delayed discharge seen after ∼2.5 hours and 5-hour duration.

Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial

“…Total gastrectomy is likely to be more complicated than distal gastrectomy because it is difficult to dissect lymph nodes along the splenic artery and perform an esophagojejunostomy. It is found that a prolonged operating time and major operative blood loss are associated with poorer outcomes, which may contribute to delayed recovery even in the presence of an established enhanced recovery program [31]. Carbohydrate loading is an important item in the ERAS protocol.…”

Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial

“…It is possible that this surgery-specific effect reflects the fact that laparoscopic resection, although it usually takes longer than open resection, induces less trauma and stress in the patient. In addition, recovery-enhancing methods are easier to apply after laparoscopic resection because of less trauma3940. Thus the clinical benefit of chewing gum may have been too weak to be observed in the entire study population or in the subgroup of those who underwent the laparoscopic procedure.…”

Operating list composition and surgical performance

“…In procedures where a skin incision is not made (such as endoscopic examination), the time taken for the procedure to be performed (defined as time from insertion to withdrawal of the endoscope for endoscopic examinations) was used. This measure was chosen because it is strongly correlated with surgeon performance, the focus of the study, and previous studies have shown a relationship between this variable and clinical outcomes across a range of operations. In addition, duration of operation is recorded routinely in Spire Healthcare hospitals, and is not affected by loss of patients to follow‐up, unlike other measures of clinical outcome such as hospital death.…”