Andrew Allison

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

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.

Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme.

Hospital readmission within 30 days of surgery has become a marker of poor quality patient care. This study aimed to investigate factors predictive of 30‐day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery (ERAS) programme.

Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Background and Objectives: Combining laparoscopy and enhanced recovery provides benefit to short-term outcomes after colorectal surgery. Advances in training and techniques have allowed surgeons to operate on cases that are technically challenging and associated with prolonged operative time. Laparoscopic techniques improve the outcome of enhanced recovery after colorectal surgery; however, there are no specifications on the effect of prolonged operations on the outcome. The objective was to elucidate the impact of prolonged surgery and blood loss on the outcome of enhanced recovery after surgery after laparoscopic colorectal surgery. Methods: Four-hundred patients who underwent elective colorectal resection on enhanced recovery after surgery in Yeovil District Hospital between 2002 and 2009 were retrospectively reviewed. Delayed discharge was defined as a prolonged length of stay beyond the mean in this series (≥8 days). Results: Three-hundred eighty-five patients were included. Median operative time was 180 minutes with a median blood loss of 100 mL. Conversion was not associated with a prolonged length of stay. Operative time and blood loss correlated with length of stay in a stepwise fashion. There were 2 cutoff points of operative time at 160 minutes and 300 minutes (5 hours), where risk of prolonged stay increased significantly (odds ratio [OR] = 2.02; 95% confidence interval [CI], 1.05–3.90; P = .027), and blood loss of >500 mL (OR = 3.114; 95% CI, 1.501–6.462, P = .002). Conclusions: Total operative timing impacts negatively on the outcome of enhanced recovery after laparoscopic colorectal resections with increased risk of delayed discharge seen after ∼2.5 hours and 5-hour duration.

Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery impact on long term survival

Hospital readmission is undesirable for patients and care providers as this can affect short‐term recovery and carries financial consequences. It is unknown if readmission has long‐term implications. We aimed to investigate the impact of 30‐day readmission on long‐term overall survival (OS) following colorectal cancer resection within enhanced recovery after surgery (ERAS) care and explore the reasons for and the severity and details of readmission episodes.

Success and Failure in Colorectal Enhanced Recovery

Enhanced recovery (ER) after surgery programmes should succeed in improving the quality of care and reducing the length of stay for the majority of patients undergoing colorectal surgery. A minority of patients however are perceived to fail by these measures and it is in these patients that we see some of the challenges and limitations faced by ER programmes.