Skip to main content
Top
Published in: Techniques in Coloproctology 8/2016

01-08-2016 | Original Article

Enhanced recovery after surgery (ERAS) pathway vs traditional care in laparoscopic rectal resection: a single-center experience

Authors: A. Vignali, U. Elmore, A. Cossu, M. Lemma, B. Calì, P. de Nardi, R. Rosati

Published in: Techniques in Coloproctology | Issue 8/2016

Login to get access

Abstract

Background

The aim of this study was to compare the outcome of an enhanced recovery after surgery (ERAS) pathway with traditional perioperative care in laparoscopic rectal resection.

Methods

A retrospective analysis of prospectively collected data was conducted. Single-center consecutive patients who underwent laparoscopic rectal surgery after an ERAS program were compared with patients who received traditional care over an 8-year period. Primary and total length of stay, and readmission, morbidity and mortality rates were analyzed. For ERAS group, the actual adherence to protocol was also evaluated.

Results

Two hundred and ninety-seven patients, 162 in the ERAS group and 135 in conventional care, were studied. Median primary and total length of stay were significantly shorter in the ERAS group (9 vs 12 days; p = 0.0001; 10 vs 12 days; p = 0.01; respectively). The ERAS group experienced a faster recovery of bowel function than the traditional care group (p = 0.0001). A similar morbidity rate was observed in the two groups (32.3 % in ERAS vs 36.1 % in traditional care p = 0.41). Readmission rates were 4.9 % in the ERAS versus 1.5 % in the traditional care group (p = 0.19). There was no mortality in either group. Overall mean compliance with the ERAS protocol was 85.7 % (range 54.4–100 %).

Conclusions

The introduction of the ERAS protocol in laparoscopic rectal resection led to a reduction in primary and total length of hospital stay without an increase in morbidity or readmission rates when compared to traditional care.
Literature
1.
go back to reference Bardram I, Foch-Jensen P, Jensen P, Crawford ME, Koehler H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition an mobilization. Lancet 345:763–764CrossRefPubMed Bardram I, Foch-Jensen P, Jensen P, Crawford ME, Koehler H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition an mobilization. Lancet 345:763–764CrossRefPubMed
2.
go back to reference Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678CrossRefPubMed Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678CrossRefPubMed
3.
go back to reference Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635PubMed Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635PubMed
4.
go back to reference Ren L, Zhu D, Wei Y et al (2012) Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg 36:407–414CrossRefPubMed Ren L, Zhu D, Wei Y et al (2012) Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg 36:407–414CrossRefPubMed
5.
go back to reference ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159CrossRef ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159CrossRef
6.
go back to reference Lassen K, Soop M, Nygren J et al (2009) Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144:961–969CrossRefPubMed Lassen K, Soop M, Nygren J et al (2009) Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144:961–969CrossRefPubMed
7.
go back to reference Kim DW, Kang SB, Lee SY, Oh HK, In MH (2013) Early rehabilitation programs after laparoscopic colorectal surgery: evidence and criticism. World J Gastroenterol 19:8543–8551CrossRefPubMedPubMedCentral Kim DW, Kang SB, Lee SY, Oh HK, In MH (2013) Early rehabilitation programs after laparoscopic colorectal surgery: evidence and criticism. World J Gastroenterol 19:8543–8551CrossRefPubMedPubMedCentral
8.
go back to reference Lindsetmo RO, Champagne B, Delaney C (2009) Laparoscopic rectal resections and fast-track surgery: What can be expected? Am J Surg 197:408–412CrossRefPubMed Lindsetmo RO, Champagne B, Delaney C (2009) Laparoscopic rectal resections and fast-track surgery: What can be expected? Am J Surg 197:408–412CrossRefPubMed
9.
go back to reference Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453CrossRefPubMedPubMedCentral Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453CrossRefPubMedPubMedCentral
10.
go back to reference Vlug MS, Wind J, Hollmann MW et al (2011) Collaborative LAFA Study Group laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 25:868–875CrossRef Vlug MS, Wind J, Hollmann MW et al (2011) Collaborative LAFA Study Group laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 25:868–875CrossRef
11.
go back to reference Huibers CJ, de Roos MA, Ong KH (2012) The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 27:751–757CrossRefPubMed Huibers CJ, de Roos MA, Ong KH (2012) The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 27:751–757CrossRefPubMed
12.
go back to reference Lee SM, Kang SB, Jang JH et al (2013) Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial. Surgical Endosc 27:3902–3909CrossRef Lee SM, Kang SB, Jang JH et al (2013) Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial. Surgical Endosc 27:3902–3909CrossRef
13.
go back to reference Chen CC, Huang IP, Liu MC, Jian JJ, Cheng SH (2011) Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery? Surg Endosc 25:1477–1483CrossRefPubMed Chen CC, Huang IP, Liu MC, Jian JJ, Cheng SH (2011) Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery? Surg Endosc 25:1477–1483CrossRefPubMed
14.
go back to reference Teeuwen PH, Bleichrodt RP, de Jong PJ, van Goor H, Bremers AJ (2011) Enhanced recovery after surgery versus conventional perioperative care in rectal surgery. Dis Colon Rectum 54:833–839CrossRefPubMed Teeuwen PH, Bleichrodt RP, de Jong PJ, van Goor H, Bremers AJ (2011) Enhanced recovery after surgery versus conventional perioperative care in rectal surgery. Dis Colon Rectum 54:833–839CrossRefPubMed
15.
go back to reference Bona S, Molteni M, Rosati R et al (2014) Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol 14:17578–17587CrossRef Bona S, Molteni M, Rosati R et al (2014) Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol 14:17578–17587CrossRef
16.
go back to reference Bianchi PP, Rosati R, Bona S et al (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50:2047–2053CrossRefPubMed Bianchi PP, Rosati R, Bona S et al (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50:2047–2053CrossRefPubMed
17.
go back to reference Delaney CP, Kehlet H, Senagore A et al (2006) Clinical consensus update® in general surgery, postoperative ileus: profiles, risk factors and definition: a framework for optimizing surgical outcomes in patients undergoing major abdominal and colorectal surgery. Clinical Consensus Update in General Surgery. http://www.clinicalwebcasts.com Delaney CP, Kehlet H, Senagore A et al (2006) Clinical consensus update® in general surgery, postoperative ileus: profiles, risk factors and definition: a framework for optimizing surgical outcomes in patients undergoing major abdominal and colorectal surgery. Clinical Consensus Update in General Surgery. http://​www.​clinicalwebcasts​.​com
18.
go back to reference Anderin K, Gustafsson UO, Thorell A, Nygren J (2015) The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program. Eur J Surg Oncol 41:724–730CrossRefPubMed Anderin K, Gustafsson UO, Thorell A, Nygren J (2015) The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program. Eur J Surg Oncol 41:724–730CrossRefPubMed
19.
go back to reference Li XH, Shi H, Wu GS, Zhang HW, Liu XN, Zhao QC (2014) Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients: a randomized controlled clinical trial. J Dig Dis 15:306–313CrossRefPubMed Li XH, Shi H, Wu GS, Zhang HW, Liu XN, Zhao QC (2014) Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients: a randomized controlled clinical trial. J Dig Dis 15:306–313CrossRefPubMed
20.
go back to reference Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X (2012) Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis 14:1009–1013CrossRefPubMed Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X (2012) Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis 14:1009–1013CrossRefPubMed
21.
go back to reference Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H (2012) Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 14:769–775CrossRefPubMed Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H (2012) Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 14:769–775CrossRefPubMed
22.
go back to reference Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljunqvist O, Lobo DN (2010) The enhanced recovery after surgery pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440CrossRefPubMed Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljunqvist O, Lobo DN (2010) The enhanced recovery after surgery pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440CrossRefPubMed
25.
go back to reference Francis NK, Mason J, Salib E et al (2015) Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis 17:148–154CrossRef Francis NK, Mason J, Salib E et al (2015) Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis 17:148–154CrossRef
26.
go back to reference Lyon A, Solomon MJ, Harrison JD (2014) A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. Word J Surg 38:1374–1380CrossRef Lyon A, Solomon MJ, Harrison JD (2014) A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. Word J Surg 38:1374–1380CrossRef
27.
go back to reference Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Enhanced Recovery After Surgery Study Group. adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577CrossRefPubMed Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Enhanced Recovery After Surgery Study Group. adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577CrossRefPubMed
Metadata
Title
Enhanced recovery after surgery (ERAS) pathway vs traditional care in laparoscopic rectal resection: a single-center experience
Authors
A. Vignali
U. Elmore
A. Cossu
M. Lemma
B. Calì
P. de Nardi
R. Rosati
Publication date
01-08-2016
Publisher
Springer Milan
Published in
Techniques in Coloproctology / Issue 8/2016
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-016-1497-4

Other articles of this Issue 8/2016

Techniques in Coloproctology 8/2016 Go to the issue