Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery
Robert H. Thiele, Kathleen Rea, Florence E. Turrentine, Charles M. Friel, Taryn E. Hassinger, Bernadette J. Goudreau, Bindu A. Umapathi, Irving L. Kron, Robert G. Sawyer, Traci L. Hedrick, Timothy L. McMurry
Journal of the American College of Surgeons, Vol. 220, Issue 4, pp. 430–443 (2015)
10.1016/j.jamcollsurg.2014.12.042
PMID: 25797725
Abstract
BACKGROUND: Colorectal surgery is associated with considerable morbidity and prolonged length of stay (LOS). Recognizing the need for improvement, we implemented an enhanced recovery (ER) protocol for all patients undergoing elective colorectal surgery at an academic institution. STUDY DESIGN: A multidisciplinary team implemented an ER protocol based on: preoperative counseling with active patient participation, carbohydrate loading, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, immediate postoperative feeding, and ambulation. Discharge requirements remained identical throughout. A before and after study design was undertaken comparing patients before (August 2012 to February 2013) and after implementation of an ER protocol (August 2013 to February 2014). Risk stratification was performed using the NSQIP risk calculator to calculate the predicted LOS for each patient based on 23 variables. RESULTS: One hundred and nine consecutive patients underwent surgery within the ER protocol compared with 98 consecutive historical controls (conventional). The risk-adjusted predicted LOS was similar for each group at 5.1 and 5.2 days. Substantial reductions were seen in LOS, morphine equivalents, intravenous fluids, return of bowel function, and overall complications with the ER group. There was a $7,129/patient reduction in direct cost, corresponding to a cost savings of $777,061 in the ER group. Patient satisfaction as measured by Press Ganey improved considerably during the study period. CONCLUSIONS: Implementation of an ER protocol led to improved patient satisfaction and substantial reduction in LOS, complication rates, and costs for patients undergoing both open and laparoscopic colorectal surgery. These data demonstrate that small investments in the perioperative environment can lead to large returns.
Topics
Field: Medicine · Subfield: Surgery
Keywords
Medicine,Colorectal surgery,Perioperative,Patient satisfaction,Surgery,Protocol (science),Complication,Abdominal surgery
MeSH Terms
All Available Versions
- Landing page — Journal of the American College of Surgeons publishedVersion
- Landing page — PubMed publishedVersion
Citations by Year
| 2026 | 2025 | 2024 | 2023 | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 |
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| 23 | 33 | 41 | 31 | 34 | 60 | 61 | 58 | 38 | 38 |
- American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway 2018 · 491
- Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery 2015 · 456
- AKI Associated with Cardiac Surgery 2014 · 320
- American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery 2016 · 200
- Enhanced Recovery Implementation in Major Gynecologic Surgeries 2016 · 189
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