The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway.

The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway.

Chand M, De’Ath HD, Rasheed S, Mehta C, Bromilow J, Qureshi T. Int J Surg. 2016 Jan;25:59-63.

What is already known:

The wide-ranging benefits, including reduced hospital length of stay (LoS), of both laparoscopic surgery and ERAS have been well established. Perioperative complications are known to increase hospital LoS and mortality.

What this paper adds:

This study included a broad range of surgical procedures performed by a single surgeon using a standardised operative and anaesthetic technique. Details of patient inclusion/exclusion or compliance to ERAS guidelines are not given but it is inferred that all patients, having been recruited consecutively during the trial period, were fully followed-up with no exclusions and that there was no deviation from ERAS guidelines. The study protocol mentions the use of diclofenac, apparently as standard, for all procedures including those involving anastomosis creation (around 80% of procedures) with a 1% anastomotic leak rate. Ten patients were noted to have had a post-operative complication prior to initial discharge of which nine were classed as minor (Clavien-Dindo classification I or II) and these patients were all discharged on day two or three. The statistical analysis, however, showed an adjusted odds ratio of 16.26 for patients suffering a complication being more likely to experience a delayed discharge from hospital. It was also suggested that the study was likely underpowered to look into the effect of complications upon hospital LoS. 27 patients (9%) required readmission, the reasons for which are not detailed. Increased BMI and duration of operation were also suggested as predictors for delayed discharge but these had adjusted odds ratios of 1.06 and 0.99 respectively and of limited clinical significance.

Ben Morrison, Guildford.