Most published enhanced recovery pathways exclude patients undergoing urgent or emergent surgeries. This study found that nonelective colorectal surgery
patients benefit significantly from the implementation of an enhanced recovery pathway, suggesting opportunities for improved outcomes
in this high-risk population.
The aim of our study was to determine if an enhanced recovery pathway (ERP
) can successfully be applied in nonelective colorectal surgery
ERPs have been shown to reduce hospital length of stay (LOS), complications, and costs after elective colorectal surgery
. Yet, little data exist regarding the benefits of ERPs in patients undergoing nonelective colorectal surgery
. We hypothesized that ERP
implementation in a nonelective colorectal surgery
population is associated with decreased postoperative LOS.
A prospectively-maintained database was used to identify consecutive patients undergoing colorectal surgery
room (ER) or hospital transfer admissions over a period from 2 years before until 1 year after implementation of a comprehensive ERP
. The primary endpoint was LOS. Secondary endpoints included total LOS [TLOS = postoperative LOS + LOS of readmission(s)], readmission rates, complication rates, 30-day mortality, and hospital costs. Univariate and multivariate analyses were performed to assess the relationship between ERP
implementation and LOS.
We identified 269 pre-ERP
and 135 ERP
patients fulfilling the inclusion criteria. Admit source (ER 43.4% vs transfers 56.7%), Charlson comorbidity index, American Society of Anesthesiologists (ASA) status, diagnosis (inflammatory bowel disease 45.8%, malignancy 19.6%, benign intestinal obstructions 10.4%, diverticulitis 9.4%, others 10.4%), and blood loss were comparable (P
> 0.05) between the cohorts. Pre-ERP
patients had a higher number of previous abdominal surgeries, whereas post-ERP
patients had more laparoscopy and more compliance with ERP
patients had a shorter postoperative LOS [6 (4, 10) vs 7 (5, 12) days; P
= 0.0007]. Hospital costs were 13.4% lower (P
= 0.004). Postoperative 30-day morbidity, mortality, and readmissions were comparable, although reoperation rate was higher in the ERP
group. On multivariate analysis, ERP
implementation and laparoscopy were the only modifiable variables independently associated with shorter LOS, whereas longer operative times and higher ASA classification were associated with longer LOS.
Patients undergoing nonelective colorectal surgery
after ER or hospital transfer admission benefit from the use of an ERP
, demonstrating decreased LOS and costs without an increase in complications.