AIM: The study aimed to identify factors that predict postoperative deviation from an enhanced recovery programme (ERP) and/or delayed discharge following colorectal surgery. METHOD: Data were prospectively collected from all patients undergoing elective laparoscopic colorectal resection between January 2006 and December 2009. They included Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) variables, body mass index (BMI), sex, preoperative serum albumin, pathology, conversion from a laparoscopic to an open approach and postoperative length of hospital stay. RESULTS: There were 176 patients (90 women) of mean age 68 years. Fifteen (9%) operations were converted from laparoscopic to open. The remainder were completed laparoscopically. Fifty-five (31%) deviated from the ERP, with most failing multiple elements. The most common reason was failure to mobilize, which often occurred in conjunction with paralytic ileus or analgesic failure. Factors independently predicting ERP deviation on multivariate analysis were pathology and intra-operative complications. The median length of stay was 5 days. Sixty-four (36%) patients had a prolonged length of stay that was predicted by age, number of procedures and ERP deviation. CONCLUSION: Pathology and intra-operative complications are independent predictors of ERP deviation. Prolonged length of stay can be predicted by age, multiple procedures and ERP deviation. Failure to mobilize should be considered as a red flag sign prompting further investigation following colorectal resection.
AIM: The study aimed to identify factors that predict postoperative deviation from an enhanced recovery programme (ERP) and/or delayed discharge following colorectal surgery. METHOD: Data were prospectively collected from all patients undergoing elective laparoscopic colorectal resection between January 2006 and December 2009. They included Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) variables, body mass index (BMI), sex, preoperative serum albumin, pathology, conversion from a laparoscopic to an open approach and postoperative length of hospital stay. RESULTS: There were 176 patients (90 women) of mean age 68 years. Fifteen (9%) operations were converted from laparoscopic to open. The remainder were completed laparoscopically. Fifty-five (31%) deviated from the ERP, with most failing multiple elements. The most common reason was failure to mobilize, which often occurred in conjunction with paralytic ileus or analgesic failure. Factors independently predicting ERP deviation on multivariate analysis were pathology and intra-operative complications. The median length of stay was 5 days. Sixty-four (36%) patients had a prolonged length of stay that was predicted by age, number of procedures and ERP deviation. CONCLUSION: Pathology and intra-operative complications are independent predictors of ERP deviation. Prolonged length of stay can be predicted by age, multiple procedures and ERP deviation. Failure to mobilize should be considered as a red flag sign prompting further investigation following colorectal resection.
Authors: David E Messenger; Nathan J Curtis; Adam Jones; Emma L Jones; Neil J Smart; Nader K Francis Journal: Surg Endosc Date: 2016-09-08 Impact factor: 4.584
Authors: N J Curtis; M Taylor; L Fraser; E Salib; E Noble; R Hipkiss; A S Allison; R Dalton; J B Ockrim; Nader K Francis Journal: Int J Colorectal Dis Date: 2017-11-29 Impact factor: 2.571
Authors: N K Francis; A Luther; E Salib; L Allanby; D Messenger; A S Allison; N J Smart; J B Ockrim Journal: Tech Coloproctol Date: 2015-06-19 Impact factor: 3.781
Authors: N J Curtis; M A West; E Salib; J Ockrim; A S Allison; R Dalton; Nader K Francis Journal: Int J Colorectal Dis Date: 2018-03-25 Impact factor: 2.571
Authors: Nader K Francis; Nathan J Curtis; Louise Crilly; Emma Noble; Tamsin Dyke; Rob Hipkiss; Richard Dalton; Andrew Allison; Emad Salib; Jonathan Ockrim Journal: Surg Endosc Date: 2018-02-13 Impact factor: 4.584
Authors: S L Kipling; K Young; J D Foster; N J Smart; A E Hunter; E Cooper; N K Francis Journal: Tech Coloproctol Date: 2013-10-01 Impact factor: 3.781
Authors: J Barr; C Boulind; J D Foster; P Ewings; J Reid; J T Jenkins; B Williams-Yesson; N K Francis Journal: Tech Coloproctol Date: 2015-02-26 Impact factor: 3.781
Authors: Oliver J Harrison; Neil J Smart; Paul White; Adela Brigic; Elinor R Carlisle; Andrew S Allison; Jonathan B Ockrim; Nader K Francis Journal: JSLS Date: 2014 Apr-Jun Impact factor: 2.172