Colorectal Patients have Speeded Recovery Time with New Care Approach.

Colorectal Surgery Patients in Enhanced Recovery

A new research study published online as an “article in press” on the Journal of the American College of Surgeons website in advance of print publication concluded that patients who participated in an enhanced recovery program following colorectal surgery left the hospital sooner and had a significantly lower hospital costs than those following a traditional pattern of care. The focus of the enhanced recovery program is to speed patient’s recovery by reducing the body’s stress responses to a surgical procedure and promoting earlier return of bodily functions. In this study patient stays were trimmed by nearly two days, on average, compared to patients receiving traditional care and there was no increase in readmission’s in the first month following surgery. In addition, the rate of surgical site infections dropped by nearly 10 percent.

Enhanced recovery includes but goes beyond “fast tract surgery” in which there is minimal invasive techniques and encouragement of early mobilization and eating by patients.  Enhanced  recovery does away with traditional preoperative fasting and bowel-emptying preparation  whenever possible and instead allows clear fluids   up to two hours before surgery.  To prevent fluid retention, anesthesiologists reduce the amount of intravenous  fluids given during the procedure. Patients also receive fewer narcotic painkillers during and after surgery. By using alternative types of pain medications the length of hospital stay is shortened because the side effects of narcotics such as vomiting and constipation are reduced.

Researchers say the U.,S, hospitals have been slow to accept components of this pattern of care. For example, “The scientific evidence that it is safe for patients to drink clear fluids up to a few hours before anesthesia is more than 25 years old. It just took us that long to adopt.”

In this study data was used from patients undergoing elective major colorectal resection  at Duke between September 2006 and March 2013. Seven hundred eighty seven patients met study criteria and were divided into 3 groups based upon surgical care provided. Three hundred were in group one who received traditional care, 165 were in group 2 receiving the enhanced recovery program but did not receive the SSI (surgical site infection) bundle, and the third group that had both enhanced recovery program and SSI bundle.

Results showed each intervention improved surgical outcomes in different ways. Those receiving enhanced recovery stayed in the hospital 1.7 days less than those receiving traditional care.  In addition, the average cost for colorectal surgical admissions fell from $31,926 before the enhanced recovery program was initiated to an inflation-adjusted $22,044 three years after it started.  The group having both enhanced recovery and the SSI bundle had a decreased rate of superficial wound infections: 6.3 percent vs 16.1 percent in the enhanced recovery only group. The rates of sepsis, a life-threatening infection, also were lower, 1.8 vs 11.2 percent. The SSI bundle included among other measures, keeping the patients temperature normal during the post op period, removing the bandages within 2 days of the operation, and washing the incision daily for one week with antiseptic solution.  Researchers concluded ” The enhanced recovery program and the SST bundle together have profoundly altered the practice of colorectal surgery at our institution and improved the quality of care.”

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