New Approach to Colorectal Surgical Care Speeds Recovery and Lowers Costs

According to research published online in theJournal of the American College of Surgeons, a new multidisciplinary approach to managing patients’ post-colorectal surgery recovery results in shorter hospital stays, fewer complications, and lower medical costs.

Patients recovering from surgery for colorectal cancer are often required to stay in the hospital for up to 10 days, and unfortunately often experience significant pain. As such, researchers at the University of Virginia Health System (UVA-Health), Charlottesville, developed a standardized approach known as enhanced recovery for colorectal surgical care to assuage the complications.

The program incorporates proven practices that lead to faster recovery into the preoperative, intraoperative, and postoperative phases of surgical patient care.

Coauthor Traci Hedrick, MD, FACS, assistant professor of surgery, and her team analyzed data from 207 patients at UVA-Health undergoing elective colorectal operations both before and after the enhanced recovery protocol took effect. Of the patient population, 109 patients were studied in the enhanced recovery group, and 98 in the conventional group.

Using the ACS NSQIP® Surgical Risk Calculator, the primary outcome was reported as risk-adjusted length of stay. Furthermore, the team noted that length of hospital stay decreased by 2.2 days, overall complication rate decreased 17%, and patient satisfaction scores with pain control increased 55%. The team was also pleasantly surprised to find that the enhanced recovery approach lowered health care costs by approximately $7,129 per patient, contributing to a total cost savings of more than $700,000.

The beauty of this program is allowing patients to grab the reigns of their own care from the beginning of the process. "The key to our success is that we brought everyone who cares for these patients together, including anesthesiologists, nursing staff, pharmacists, nutritionists, and we coordinated every detail of their care," said Hedrick. "This recovery plan was a quality initiative right from the start."

The researchers realizedprior to initiating the new protocol that patient stays were on average 1.6 days longer than the NSQIP predicted length of stay, whereas, afterward, the average length of patients’ required stay dipped to about half a day below what the NSQIP predicted.

While the team hopes to also work on potentially establishing a similar protocol beyond colorectal cancer procedures, Hendrick concluded, "I think in five years this will be the standard way that we are managing patients, because the results are so dramatic," Hedrick said. "It provides higher quality at lower cost, which is the ultimate goal."