BACKGROUND: Enhanced recovery after colon surgery has not been widely adopted in the United States and Europe, despite evidence that postoperative complications and hospital length of stay are decreased. OBJECTIVE: We sought to evaluate the introduction of a comprehensive care process for enhanced recovery after colon surgery in 8 community hospitals. DESIGN: A system-wide, surgeon-directed, multidisciplinary committee developed a comprehensive enhanced-care quality-improvement program. Surgeons and operations leaders in each hospital developed the internal structure to implement the process. PATIENTS: Surgeons had the option of entering or not entering patients in the enhanced-care pathway. Other than trauma patients, there were no exclusion criteria. MAIN OUTCOME MEASURES: To limit selection bias, the study population included all patients undergoing colon resections (those entered and not entered in the care process). Length of stay, postoperative days, hospital costs, 30-day readmission rate, and return to surgery for the study population were compared with a 2-year historical baseline. RESULTS: Forty-two percent of the study population was entered in the enhanced-care process. The average length of stay and the number of postoperative days in the study population decreased by 1.5 (P < .0001) and 1.3 (P < .0001) days. The rate of readmissions and returns to surgery remained stable (P > .05), and the average hospital cost decreased by $1763 (P = .02). Generalized linear regression analysis demonstrated that the enhanced-care process was a more significant variable than was the surgical approach (laparoscopic vs open surgery) in decreasing length of stay. LIMITATIONS: The degree of compliance with care process elements and the relative contribution of each element of the care process are unknown. CONCLUSIONS: A comprehensive enhanced-care colon surgery care process was successfully introduced in a community hospital system, as indicated by the clinical outcome measures.
BACKGROUND: Enhanced recovery after colon surgery has not been widely adopted in the United States and Europe, despite evidence that postoperative complications and hospital length of stay are decreased. OBJECTIVE: We sought to evaluate the introduction of a comprehensive care process for enhanced recovery after colon surgery in 8 community hospitals. DESIGN: A system-wide, surgeon-directed, multidisciplinary committee developed a comprehensive enhanced-care quality-improvement program. Surgeons and operations leaders in each hospital developed the internal structure to implement the process. PATIENTS: Surgeons had the option of entering or not entering patients in the enhanced-care pathway. Other than traumapatients, there were no exclusion criteria. MAIN OUTCOME MEASURES: To limit selection bias, the study population included all patients undergoing colon resections (those entered and not entered in the care process). Length of stay, postoperative days, hospital costs, 30-day readmission rate, and return to surgery for the study population were compared with a 2-year historical baseline. RESULTS: Forty-two percent of the study population was entered in the enhanced-care process. The average length of stay and the number of postoperative days in the study population decreased by 1.5 (P < .0001) and 1.3 (P < .0001) days. The rate of readmissions and returns to surgery remained stable (P > .05), and the average hospital cost decreased by $1763 (P = .02). Generalized linear regression analysis demonstrated that the enhanced-care process was a more significant variable than was the surgical approach (laparoscopic vs open surgery) in decreasing length of stay. LIMITATIONS: The degree of compliance with care process elements and the relative contribution of each element of the care process are unknown. CONCLUSIONS: A comprehensive enhanced-care colon surgery care process was successfully introduced in a community hospital system, as indicated by the clinical outcome measures.
Authors: Antonio Arroyo; José Manuel Ramirez; Daniel Callejo; Xavier Viñas; Sergio Maeso; Roger Cabezali; Elena Miranda Journal: Int J Colorectal Dis Date: 2012-05-27 Impact factor: 2.571
Authors: Thomas D Martin; Talya Lorenz; Jane Ferraro; Kevin Chagin; Richard M Lampman; Karen L Emery; Joan E Zurkan; Jami L Boyd; Karin Montgomery; Rachel E Lang; James F Vandewarker; Robert K Cleary Journal: Surg Endosc Date: 2015-12-22 Impact factor: 4.584
Authors: Vijaya Gottumukkala; Thomas A Aloia; Ryan W Day; Sharon Fielder; John Calhoun; Henrik Kehlet Journal: Br J Surg Date: 2015-09-14 Impact factor: 6.939