Enhanced Recovery After Colorectal Surgery Cuts Costs, Hospital Readmissions

Could early mobilization and feeding after colorectal surgery reduce hospital stays and readmission rates? A team of researchers from Duke University Hospital believes so.

For most patients with uncomplicated surgeries, length of hospital stay is closely related to the duration of postoperative ileus. Once the attending surgeon hears bowel sounds, the patient is discharged from the hospital within 2 days.

However, in the May 2014 issue of Anesthesia & Analgesia, the Duke research team described their enhanced recovery after surgery (ERAS) approach as an interdisciplinary effort that eliminates ileus as a factor.

“Enhanced recovery is about change management; it’s getting the team together — including nurses, anesthesiologists, surgeons, and patients — with everyone understanding the expectations of how to do things differently and improve patient care,” senior author and anesthesiology professor Tong J. Gan, MD, MHS, explained. According to the Gan, ERAS eliminates preoperative fasting periods and bowel evacuations, instead mobilizing patients and reintroducing food quickly after surgery.

In their study, the researchers collected data from 241 patients who consecutively underwent open or laparoscopic colorectal surgery. They included 99 patients who received traditional care, which involved fasting before surgery and bowel evacuation with laxative treatments, and 142 patients who received ERAS-based care.

ERAS included patient education about what to expect and eliminated bowel preparation; patients were also allowed to drink clear fluids until 3 hours before their surgeries. After surgery, the researchers withheld food until bowel sounds were restored. The surgical care team was careful to avoid administering fluid excess to patients in the surgical suite, as it has been associated with adverse outcomes. Patients were also encouraged to drink liquids and mobilize on the day of surgery and for at least 6 hours every subsequent day.

The researchers reported the enhanced recovery approach used for colorectal surgery cut hospital admissions from an average of 7 days to 5, reduced the rate of readmissions by half, and lowered the incidence of urinary tract infections (UTIs). The findings were particularly robust in patients who underwent laproscopic surgery, as the authors estimated about $2,000 in savings per patient. Other studies conducted around the world — especially in Europe, where ERAS has become a common approach — have reported similar findings.