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Colorectal Dis. 2016 Jun;18(6):603-11. doi: 10.1111/codi.13253.

Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial.

Author information

1
Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
2
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
3
Department of Anesthesiology, Haukeland University Hospital, Bergen, Norway.
4
Department of Gastrointestinal Surgery, Haugesund Hospital, Haugesund, Norway.
5
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.

Abstract

AIM:

The aim of this randomized clinical trial was to compare patients treated using a multimodal approach [enhanced recovery after surgery (ERAS)], with a special focus on counselling, to patients treated in a standard conventional care pathway, who underwent elective colorectal resection.

METHOD:

In a single-centre trial, adult patients eligible for open or laparoscopic colorectal resection were randomized to an ERAS programme or standard care. The primary end-point was postoperative total hospital stay. Identical discharge criteria were defined for both treatment groups. Secondary end-points included postoperative complications, postoperative C-reactive protein levels, postoperative hospital stay, readmission rate and mortality. All parameters were recorded before operation, on the day of surgery and daily thereafter until discharge.

RESULTS:

Total hospital stay was significantly shorter among patients randomized to ERAS than among the standard group [median 5 days (range 2-50 days) vs median 8 days (range 2-48 days); P = 0.001]. The two treatment groups exhibited similar outcomes regarding overall major and minor morbidity, reoperation rate, readmission rate and 30-day mortality. There were also no differences in tolerance of enteral nutrition or in the inflammatory response, as reflected by postoperative C-reactive protein levels.

CONCLUSION:

ERAS care was associated with a significantly shorter length of hospital stay. Without any difference in surgical or general complications, tolerance of enteral nutrition or postoperative C-reactive protein levels, peri-operative information and guidance for ensuring that patients comply with the ERAS approach appear to be important factors to reduce the length of hospital stay.

KEYWORDS:

Colorectal surgery; ERAS; complication; counselling

PMID:
27273854
DOI:
10.1111/codi.13253
[Indexed for MEDLINE]

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