A fast-track recovery protocol improves outcomes in elective laparoscopic colectomy for diverticulitis

David Larson, Niles J. Batdorf, John G. Touzios, Robert R. Cima, Heidi K. Chua, John H. Pemberton, Eric Dozois

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Fast-track (FT) postoperative protocols have been shown to be highly beneficial in open colectomy. Some have questioned the necessity of an FT protocol in the setting of laparoscopic colectomy because hospital stays are short and morbidity is low compared with open surgery. We set out to determine whether an FT protocol has any utility in the setting of elective laparoscopic colectomy. Study Design: A retrospective review was conducted on a cohort of 334 patients who underwent elective laparoscopic sigmoid resection for diverticulitis from 1998 to 2008, at Mayo Clinic, a tertiary care center in Rochester, MN. There were 235 patients who were managed with traditional postoperative care, and 99 who were managed with an FT protocol initiated in 2006. The main outcomes measures were time to soft diet, length of stay, overall morbidity, and readmission rate. Results: Times to soft diet (mean 2.3 vs 3.6 days), and first bowel movement (mean 2.6 vs 3.5 days) were shorter in the FT group (p < 0.001). The median lengths of stay were 3 days (interquartile range 3 to 4 days) and 5 days (interquartile range 4 to 6 days) for the FT and non-FT groups, respectively (p < 0.001). Morbidity was significantly lower in the FT group compared with the non-FT group (15.2% vs 25.5%, p < 0.03). The 30-day readmission rate was 2.9% for the FT group and 7.6% for the non-FT group (p = NS). There were no deaths in either group. Conclusions: Even in patients undergoing laparoscopic colectomy, FT protocols further improve the speed of gastrointestinal recovery, shorten the length of stay, and decrease morbidity.

Original languageEnglish (US)
Pages (from-to)485-489
Number of pages5
JournalJournal of the American College of Surgeons
Volume211
Issue number4
DOIs
StatePublished - Oct 2010

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Diverticulitis
Colectomy
Length of Stay
Morbidity
Diet
Postoperative Care
Sigmoid Colon
Tertiary Care Centers
Outcome Assessment (Health Care)

Keywords

  • Fast-track
  • FT
  • HALS
  • Hand-assisted laparoscopic surgery
  • LAP
  • Laparoscopic-assisted surgery

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

A fast-track recovery protocol improves outcomes in elective laparoscopic colectomy for diverticulitis. / Larson, David; Batdorf, Niles J.; Touzios, John G.; Cima, Robert R.; Chua, Heidi K.; Pemberton, John H.; Dozois, Eric.

In: Journal of the American College of Surgeons, Vol. 211, No. 4, 10.2010, p. 485-489.

Research output: Contribution to journalArticle

Larson, David ; Batdorf, Niles J. ; Touzios, John G. ; Cima, Robert R. ; Chua, Heidi K. ; Pemberton, John H. ; Dozois, Eric. / A fast-track recovery protocol improves outcomes in elective laparoscopic colectomy for diverticulitis. In: Journal of the American College of Surgeons. 2010 ; Vol. 211, No. 4. pp. 485-489.
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abstract = "Background: Fast-track (FT) postoperative protocols have been shown to be highly beneficial in open colectomy. Some have questioned the necessity of an FT protocol in the setting of laparoscopic colectomy because hospital stays are short and morbidity is low compared with open surgery. We set out to determine whether an FT protocol has any utility in the setting of elective laparoscopic colectomy. Study Design: A retrospective review was conducted on a cohort of 334 patients who underwent elective laparoscopic sigmoid resection for diverticulitis from 1998 to 2008, at Mayo Clinic, a tertiary care center in Rochester, MN. There were 235 patients who were managed with traditional postoperative care, and 99 who were managed with an FT protocol initiated in 2006. The main outcomes measures were time to soft diet, length of stay, overall morbidity, and readmission rate. Results: Times to soft diet (mean 2.3 vs 3.6 days), and first bowel movement (mean 2.6 vs 3.5 days) were shorter in the FT group (p < 0.001). The median lengths of stay were 3 days (interquartile range 3 to 4 days) and 5 days (interquartile range 4 to 6 days) for the FT and non-FT groups, respectively (p < 0.001). Morbidity was significantly lower in the FT group compared with the non-FT group (15.2{\%} vs 25.5{\%}, p < 0.03). The 30-day readmission rate was 2.9{\%} for the FT group and 7.6{\%} for the non-FT group (p = NS). There were no deaths in either group. Conclusions: Even in patients undergoing laparoscopic colectomy, FT protocols further improve the speed of gastrointestinal recovery, shorten the length of stay, and decrease morbidity.",
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AU - Batdorf, Niles J.

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AU - Cima, Robert R.

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AU - Pemberton, John H.

AU - Dozois, Eric

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AB - Background: Fast-track (FT) postoperative protocols have been shown to be highly beneficial in open colectomy. Some have questioned the necessity of an FT protocol in the setting of laparoscopic colectomy because hospital stays are short and morbidity is low compared with open surgery. We set out to determine whether an FT protocol has any utility in the setting of elective laparoscopic colectomy. Study Design: A retrospective review was conducted on a cohort of 334 patients who underwent elective laparoscopic sigmoid resection for diverticulitis from 1998 to 2008, at Mayo Clinic, a tertiary care center in Rochester, MN. There were 235 patients who were managed with traditional postoperative care, and 99 who were managed with an FT protocol initiated in 2006. The main outcomes measures were time to soft diet, length of stay, overall morbidity, and readmission rate. Results: Times to soft diet (mean 2.3 vs 3.6 days), and first bowel movement (mean 2.6 vs 3.5 days) were shorter in the FT group (p < 0.001). The median lengths of stay were 3 days (interquartile range 3 to 4 days) and 5 days (interquartile range 4 to 6 days) for the FT and non-FT groups, respectively (p < 0.001). Morbidity was significantly lower in the FT group compared with the non-FT group (15.2% vs 25.5%, p < 0.03). The 30-day readmission rate was 2.9% for the FT group and 7.6% for the non-FT group (p = NS). There were no deaths in either group. Conclusions: Even in patients undergoing laparoscopic colectomy, FT protocols further improve the speed of gastrointestinal recovery, shorten the length of stay, and decrease morbidity.

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