Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: Early prediction model

White, P.; Smart, N. J.; White, Paul; Allison, A. S.; Ockrim, J. B.; Kennedy, R. H.; Francis, N. K.

Abstract

Aim Enhanced recovery after surgery (ERAS) programmes are well established, but deviation from the postoperative elements may result in delayed discharge. Early identification of such patients may allow remedial action to be taken. The aims of this study were to investigate factors associated with delayed discharge and to produce a predictive scoring system for ERAS failure. Method A retrospective review was carried out of case notes of patients who underwent elective laparoscopic colorectal resection and ERAS at Yeovil District Hospital between 2002 and 2009. Univariate and multivariate analyses were performed and binary logistic regression was used to model a predictive scoring system. Results In all, 385 patient records were reviewed with a median length of stay of 6days; 122 (31%) patients stayed longer than 1week (delayed discharge) and 159 (41%) deviated in up to two postoperative ERAS factors. Patient demographic factors were not predictive of delayed discharge. Deviation from ERAS factors at the end of the first postoperative day, including continued intravenous fluid infusion, lack of functioning epidural, inability to mobilize, vomiting requiring nasogastric tube insertion and re-insertion of urinary catheter, were strongly associated with delayed discharge. A five-element predictive scoring system for ERAS failure and delayed discharge was formulated. Conclusion Enhanced recovery failure and delayed discharge after laparoscopic colorectal surgery can be predicted by the early deviation from postoperative factors of an ERAS programme. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

• Journal Article Type: Article
• Publication Date: Oct 1, 2012
• Journal: Colorectal Disease
• Print ISSN: 1462-8910
• Electronic ISSN: 1463-1318
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 10
• Pages: e727-e734
• DOI: https://doi.org/10.1111/j.1463-1318.2012.03096.x
• Keywords: enhanced recovery after surgery, ERAS, laparoscopic surgery, early prediction model
• Public URL: https://uwe-repository.worktribe.com/output/943428
• Publisher URL: http://dx.doi.org/10.1111/j.1463-1318.2012.03096.x