Top

International Journal of Colorectal Disease

Published in:

01-12-2012 | Original Article

Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection

Authors: Antonio Arroyo, José Manuel Ramirez, Daniel Callejo, Xavier Viñas, Sergio Maeso, Roger Cabezali, Elena Miranda, Spanish Working Group in Fast Track Surgery (GERM)

Published in: International Journal of Colorectal Disease | Issue 12/2012

Abstract

Purpose

The aim of this study was to see whether the application of the enhanced recovery programme for colorectal resection improves the results and, in turn, the influence of complexity and size of the hospitals in applying this and its results.

Methods

A multi-centric prospective study was controlled with a retrospective group. The prospective operation group included 300 patients with elective colorectal resection due to cancer. The centres were divided depending on size and complexity in large reference centres (group 1) and area and basic general hospitals (group 2). The retrospective control group included 201 patients with the same characteristics attended before the application of the programme. Completion of categories of the protocol, complications, perioperative mortality and stay in hospital were recorded.

Results

The introduction of the programme achieved a reduction in mortality (1 vs. 4 %), morbidity (26 vs. 39 %) and preoperative (<24 h vs. 3 days) and postoperative (7 vs. 11 days) stays (p < 0.01). There was greater fulfilment of protocol in group 2 with the mean number of items completed at 8.46 and 60 % completed compared with the hospitals in group 1 (7.70 completed items and 55 % completion). The size of the hospital had no relation to the rate of complications (21.3 vs. 26.5 %). In smaller sized and less complex hospitals, the average length of stay was 1.88 days less than in those of greater size (6.45 vs. 8.33 days).

Conclusion

Patients treated according to an enhanced recovery programme develop significantly fewer complications and have a shorter hospital stay. The carrying out of protocol is greater in smaller and less complex hospitals and is directly related to a shorter stay in hospital.

Roig JV, Rodríguez-Carrillo R, García-Armengol J et al (2007) Multimodal rehabilitation in colorectal surgery. On resistance to change in surgery and the demands of society. Cir Esp 81:307–315PubMedCrossRef

Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617PubMedCrossRef

Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641PubMedCrossRef

Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362:1225–1230PubMedCrossRef

Mitchell RE, Lee BT, Cookson MS et al (2009) Immediate surgical outcomes for radical prostatectomy in the University HealthSystem Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48,000 patients. BJU Int 104:1442–1445PubMedCrossRef

Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504PubMedCrossRef

Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859PubMedCrossRef

Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92:1354–1362PubMedCrossRef

Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872PubMedCrossRef

10.

Maessen J, Dejong CH, Hausel J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231PubMedCrossRef

11.

Stephen AE, Berger DL (2003) Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection. Surgery 133:277–282PubMedCrossRef

12.

Ramirez JM, Blasco JA, Roig JV, Maeso S, Casal JE, Esteban F, Callejo D, Spanish working group on fast track surgery (2011) Enhanced recovery in colorectal surgery: a multicentre study. BMC Surg 11:9PubMedCrossRef

13.

Archibald LH, Ott MJ, Gale CM, Zhang J, Peters MS, Stroud GK (2011) Enhanced recovery after colon surgery in a community hospital system. Dis Colon Rectum 54(7):840–845PubMedCrossRef

14.

Kahokehr AA, Sammour T, Sahakian V, Zargar-Shoshtari K, Hill AG (2011) Influences on length of stay in an enhanced recovery programme after colonic surgery. Colorectal Dis 13:594–599PubMedCrossRef

15.

Walter CJ, Watson JT, Pullan RD, Kenefick NJ, Mitchell SJ, Defriend DJ (2011) Enhanced recovery in major colorectal surgery: safety and efficacy in an unselected surgical population at a UK district general hospital. Surgeon 9:259–264PubMed

16.

Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJHM (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev Issue 2. Art. No.: CD007635. doi:10.1002/14651858.CD007635.pub2

17.

Schwenk W, Gunther N, Wendling P et al (2008) “Fast-track” rehabilitation for elective colonic surgery in Germany—prospective observational data from a multi-centre quality assurance programme. Int J Colorectal Dis 23:93–99PubMedCrossRef

18.

Braumann C, Guenther N, Wendling P, Fast-Track Colon II Quality Assurance Group et al (2009) Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’. Dig Surg 26:123–129PubMedCrossRef

19.

Schwarzbach M, Hasenberg T, Linke M, Kienle P, Post S, Ronellenfitsch U (2011) Perioperative quality of care is modulated by process management with clinical pathways for fast-track surgery of the colon. Int J Colorectal Dis 26:1567–1575PubMedCrossRef

20.

Ahmed J, Lim M, Khan S, McNaught C, Macfie J (2010) Predictors of length of stay in patients having elective colorectal surgery within an enhanced recovery protocol. Int J Surg 8:628–632PubMedCrossRef

21.

Nygren J, Soop M, Thorell A, Sree NK, Ljungqvist O (1999) Preoperative oral carbohydrates and postoperative insulin resistance. Clin Nutr 18:117–120PubMedCrossRef

22.

Cheatham ML, Chapman WC, Key SP, Sawyers JL (1995) A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 221:469–476PubMedCrossRef

23.

Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O (1998) Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg 133:309–314PubMedCrossRef

24.

Urbach DR, Kennedy ED, Cohen MM (1999) Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 229:174–180PubMedCrossRef

25.

Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910PubMedCrossRef

26.

Daltroy LH, Morlino CI, Eaton HM, Poss R, Liang MH (1998) Preoperative education for total hip and knee replacement patients. Arthritis Care Res 11:469–478PubMedCrossRef

27.

Mowatt G, Houston G, Hernandez R, de Verteuil R, Fraser C, Cuthbertson B, Vale L (2009) Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients. Health Technol Assess 13:1–118

28.

Di Fronzo LA, Cymerman J, O’Connell TX (1999) Factors affecting early postoperative feeding following elective open colon resection. Arch Surg 134:941–945PubMedCrossRef

Title: Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection
Authors: Antonio Arroyo
José Manuel Ramirez
Daniel Callejo
Xavier Viñas
Sergio Maeso
Roger Cabezali
Elena Miranda
Spanish Working Group in Fast Track Surgery (GERM)
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 12/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1497-4

At a glance: The STEP trials

Springer Medicine

Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2012

Life-threatening severe anaphylactic reactions in patients receiving oxaliplatin chemotherapy

The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials

Sphingosine kinase 1 enhances colon cancer cell proliferation and invasion by upregulating the production of MMP-2/9 and uPA via MAPK pathways

Association between increased tumor necrosis factor alpha levels and acquired activated protein C resistance in patients with metastatic colorectal cancer

Letter to the editor: a meta-analysis of MMP-2 expression on the survival of patients with colorectal cancer

The sensitivity and specificity of guaiac and immunochemical fecal occult blood tests for the detection of advanced colonic adenomas and cancer