Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery

David Larson, J. K. Lovely, R. R. Cima, Eric Dozois, H. Chua, B. G. Wolff, J. H. Pemberton, R. R. Devine, M. Huebner

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background The aim of the study was to assess which aspects of an enhanced recovery programme are associated with better outcomes following laparoscopic colorectal surgery. Methods A database of laparoscopic colorectal procedures performed in 2011 was reviewed. Elements of the enhanced recovery programme and compliance were evaluated for short-term (30-day) outcomes. Individual elements included gabapentin, celecoxib, intrathecal analgesia, diet, postoperative fluids, and paracetamol/non-steroidal anti-inflammatory drug pain management. Results Five hundred and forty-one consecutive procedures were included. Compliance with the enhanced recovery programme elements ranged from 82·4 to 99·3 per cent. Median length of hospital stay was 3 (i.q.r. 2-5) days, with 25·9 per cent of patients discharged within 48 h. Patients without complications had a median length of stay of 3 (i.q.r. 2-4) days if compliant and 3 (3-5) days if not (P < 0·001). Low oral opiate intake (oral morphine equivalent of less than 30 mg) (odds ratio (OR) 1·97, 95 per cent confidence interval 1·29 to 3·03; P = 0·002), full compliance (OR 2·36, 1·42 to 3·90; P < 0·001) and high surgeon volume (more than 100 cases per year) (OR 1·50, 1·19 to 1·89; P < 0·001) were associated with discharge within 48 h. Compliance with the elements of oral intake and fluid management in the first 48 h was associated with a reduced rate of complications (8·1 versus 19·6 per cent; P = 0·001). Median oral opiate intake was 37·5 (i.q.r. 0-105) mg in 48 h, with 26·2 per cent of patients receiving no opiates. Conclusion Compliance with an enhanced recovery pathway was associated with less opiate use, fewer complications and a shorter hospital stay. Standardized pathways improve outcomes

Original languageEnglish (US)
Pages (from-to)1023-1030
Number of pages8
JournalBritish Journal of Surgery
Volume101
Issue number8
DOIs
StatePublished - 2014

Fingerprint

Opiate Alkaloids
Colorectal Surgery
Laparoscopy
Length of Stay
Celecoxib
Odds Ratio
Compliance
Pain Management
Acetaminophen
Analgesia
Morphine
Anti-Inflammatory Agents
Databases
Confidence Intervals
Diet
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Surgery

Cite this

Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. / Larson, David; Lovely, J. K.; Cima, R. R.; Dozois, Eric; Chua, H.; Wolff, B. G.; Pemberton, J. H.; Devine, R. R.; Huebner, M.

In: British Journal of Surgery, Vol. 101, No. 8, 2014, p. 1023-1030.

Research output: Contribution to journalArticle

Larson, D, Lovely, JK, Cima, RR, Dozois, E, Chua, H, Wolff, BG, Pemberton, JH, Devine, RR & Huebner, M 2014, 'Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery', British Journal of Surgery, vol. 101, no. 8, pp. 1023-1030. https://doi.org/10.1002/bjs.9534
Larson, David ; Lovely, J. K. ; Cima, R. R. ; Dozois, Eric ; Chua, H. ; Wolff, B. G. ; Pemberton, J. H. ; Devine, R. R. ; Huebner, M. / Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. In: British Journal of Surgery. 2014 ; Vol. 101, No. 8. pp. 1023-1030.
@article{ddf9dddbafa746fcae82aa62b0c07e50,
title = "Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery",
abstract = "Background The aim of the study was to assess which aspects of an enhanced recovery programme are associated with better outcomes following laparoscopic colorectal surgery. Methods A database of laparoscopic colorectal procedures performed in 2011 was reviewed. Elements of the enhanced recovery programme and compliance were evaluated for short-term (30-day) outcomes. Individual elements included gabapentin, celecoxib, intrathecal analgesia, diet, postoperative fluids, and paracetamol/non-steroidal anti-inflammatory drug pain management. Results Five hundred and forty-one consecutive procedures were included. Compliance with the enhanced recovery programme elements ranged from 82·4 to 99·3 per cent. Median length of hospital stay was 3 (i.q.r. 2-5) days, with 25·9 per cent of patients discharged within 48 h. Patients without complications had a median length of stay of 3 (i.q.r. 2-4) days if compliant and 3 (3-5) days if not (P < 0·001). Low oral opiate intake (oral morphine equivalent of less than 30 mg) (odds ratio (OR) 1·97, 95 per cent confidence interval 1·29 to 3·03; P = 0·002), full compliance (OR 2·36, 1·42 to 3·90; P < 0·001) and high surgeon volume (more than 100 cases per year) (OR 1·50, 1·19 to 1·89; P < 0·001) were associated with discharge within 48 h. Compliance with the elements of oral intake and fluid management in the first 48 h was associated with a reduced rate of complications (8·1 versus 19·6 per cent; P = 0·001). Median oral opiate intake was 37·5 (i.q.r. 0-105) mg in 48 h, with 26·2 per cent of patients receiving no opiates. Conclusion Compliance with an enhanced recovery pathway was associated with less opiate use, fewer complications and a shorter hospital stay. Standardized pathways improve outcomes",
author = "David Larson and Lovely, {J. K.} and Cima, {R. R.} and Eric Dozois and H. Chua and Wolff, {B. G.} and Pemberton, {J. H.} and Devine, {R. R.} and M. Huebner",
year = "2014",
doi = "10.1002/bjs.9534",
language = "English (US)",
volume = "101",
pages = "1023--1030",
journal = "British Journal of Surgery",
issn = "0007-1323",
publisher = "John Wiley and Sons Ltd",
number = "8",

}

TY - JOUR

T1 - Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery

AU - Larson, David

AU - Lovely, J. K.

AU - Cima, R. R.

AU - Dozois, Eric

AU - Chua, H.

AU - Wolff, B. G.

AU - Pemberton, J. H.

AU - Devine, R. R.

AU - Huebner, M.

PY - 2014

Y1 - 2014

N2 - Background The aim of the study was to assess which aspects of an enhanced recovery programme are associated with better outcomes following laparoscopic colorectal surgery. Methods A database of laparoscopic colorectal procedures performed in 2011 was reviewed. Elements of the enhanced recovery programme and compliance were evaluated for short-term (30-day) outcomes. Individual elements included gabapentin, celecoxib, intrathecal analgesia, diet, postoperative fluids, and paracetamol/non-steroidal anti-inflammatory drug pain management. Results Five hundred and forty-one consecutive procedures were included. Compliance with the enhanced recovery programme elements ranged from 82·4 to 99·3 per cent. Median length of hospital stay was 3 (i.q.r. 2-5) days, with 25·9 per cent of patients discharged within 48 h. Patients without complications had a median length of stay of 3 (i.q.r. 2-4) days if compliant and 3 (3-5) days if not (P < 0·001). Low oral opiate intake (oral morphine equivalent of less than 30 mg) (odds ratio (OR) 1·97, 95 per cent confidence interval 1·29 to 3·03; P = 0·002), full compliance (OR 2·36, 1·42 to 3·90; P < 0·001) and high surgeon volume (more than 100 cases per year) (OR 1·50, 1·19 to 1·89; P < 0·001) were associated with discharge within 48 h. Compliance with the elements of oral intake and fluid management in the first 48 h was associated with a reduced rate of complications (8·1 versus 19·6 per cent; P = 0·001). Median oral opiate intake was 37·5 (i.q.r. 0-105) mg in 48 h, with 26·2 per cent of patients receiving no opiates. Conclusion Compliance with an enhanced recovery pathway was associated with less opiate use, fewer complications and a shorter hospital stay. Standardized pathways improve outcomes

AB - Background The aim of the study was to assess which aspects of an enhanced recovery programme are associated with better outcomes following laparoscopic colorectal surgery. Methods A database of laparoscopic colorectal procedures performed in 2011 was reviewed. Elements of the enhanced recovery programme and compliance were evaluated for short-term (30-day) outcomes. Individual elements included gabapentin, celecoxib, intrathecal analgesia, diet, postoperative fluids, and paracetamol/non-steroidal anti-inflammatory drug pain management. Results Five hundred and forty-one consecutive procedures were included. Compliance with the enhanced recovery programme elements ranged from 82·4 to 99·3 per cent. Median length of hospital stay was 3 (i.q.r. 2-5) days, with 25·9 per cent of patients discharged within 48 h. Patients without complications had a median length of stay of 3 (i.q.r. 2-4) days if compliant and 3 (3-5) days if not (P < 0·001). Low oral opiate intake (oral morphine equivalent of less than 30 mg) (odds ratio (OR) 1·97, 95 per cent confidence interval 1·29 to 3·03; P = 0·002), full compliance (OR 2·36, 1·42 to 3·90; P < 0·001) and high surgeon volume (more than 100 cases per year) (OR 1·50, 1·19 to 1·89; P < 0·001) were associated with discharge within 48 h. Compliance with the elements of oral intake and fluid management in the first 48 h was associated with a reduced rate of complications (8·1 versus 19·6 per cent; P = 0·001). Median oral opiate intake was 37·5 (i.q.r. 0-105) mg in 48 h, with 26·2 per cent of patients receiving no opiates. Conclusion Compliance with an enhanced recovery pathway was associated with less opiate use, fewer complications and a shorter hospital stay. Standardized pathways improve outcomes

UR - http://www.scopus.com/inward/record.url?scp=84902247089&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902247089&partnerID=8YFLogxK

U2 - 10.1002/bjs.9534

DO - 10.1002/bjs.9534

M3 - Article

C2 - 24828373

AN - SCOPUS:84902247089

VL - 101

SP - 1023

EP - 1030

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 8

ER -